Paying for Care
The majority of Clover Health’s Medicare Advantage plans have no monthly plan premium, which means that after you pay your monthly Part B premium, there is no additional premium for you to pay. Your monthly Part B premium is paid directly to Medicare, usually through a deduction to your social security check.
We understand that cost is a factor in your healthcare choices. The total amount you'll spend on your healthcare goes beyond monthly premiums. What you pay in copays and coinsurance when you receive care and at the pharmacy can be a big part of your financial responsibility. To estimate your costs for each of your medications more accurately, check our formulary. You can also learn the cost-shares for the medical services you use in your Evidence of Coverage. It's okay to ask a provider to estimate your financial responsibility.
Copayments and coinsurance are two different kinds of cost-shares that our plans use to define your financial responsibility for covered services or items. A copay, or copayment, is a fixed amount of money that you pay for a covered benefit. Your plan pays the remainder of the cost. Coinsurance is the percentage of the total cost of a covered service or item that you pay. Your plan pays the rest.
An explanation of benefits (EOB) is the activity history for claims submitted to Clover Health by your doctors or other providers. An EOB is not a bill, it's a notification of claims that have been submitted to Clover Health that are paid or unpaid. If a claim is not paid, don't be alarmed; a provider may need to resubmit the claim before it's paid. If you receive a bill directly from the provider asking for payments, please contact Member Services and we can clarify whether the bill is your responsibility or not.
Extra help is available to Medicare beneficiaries who need assistance paying for care. We're happy to help you learn more about what's available. Depending on your circumstances, the Medicare Low-Income Subsidy (LIS), State Pharmaceutical Assistance Programs (SPAP), discount programs, Medicaid, and state premium assistance programs like SLMB can all help lower your costs. To learn what's available in your area and how to apply, contact Member Services at 1-888-778-1478 (TTY 711) 8 am–8 pm local time, 7 days a week.*
*We are open from 8 am–8 pm local time, 7 days a week. From April 1st through September 30th, alternate technologies (for example, voicemail) will be used on the weekends and holidays.
Last Updated: 2024-08-08
Clover Health is a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO) with a Medicare contract. Enrollment in Clover Health depends on contract renewal. You must continue to pay your Medicare Part B premium. For plans that provide drug coverage, the formulary may change during the year. Out-of-network/non-contracted providers are under no obligation to treat Clover members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare beneficiaries may also enroll in Clover Health through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-778-1478 (TTY 711).
ATENCIÓN: Si usted habla español, tenemos servicios de asistencia lingüística disponibles para usted sin costo alguno. Llame al 1-888-778-1478 (TTY 711).
小贴士： 如果您说普通话， 欢迎使用免费语言协助服务。 请拨 1-888-778-1478 (TTY 711).
Disclaimer
This information is not a complete description of benefits. Call 1-888-778-1478 (TTY 711) for more information. Limitations, copayments, and restrictions may apply. Plan performance Medicare Star Ratings are assessed each year and may change from one year to the next. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. For sales/marketing complaints, contact Clover Health at 1-888-778-1478 (TTY 711) or 1-800-MEDICARE (if possible, please be able to provide the agent or broker's name).
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