2023 Clever Care Value Medicare Advantage (HMO)

Clever Care Value Medicare Advantage (HMO) H7607-008 is a 2023 Medicare Advantage Plan or Part-C by Clever Care Health Plan available to residents in California. This plan includes additional prescription drug (Part-D) coverage. Clever Care Health Plan Clever Care Value Medicare Advantage (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,000 out-of-pocket. This can be an extremely nice safety net.

Clever Care Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Clever Care Value Medicare Advantage (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Clever Care Health Plan and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Clever Care Health Plan except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in California.




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2023 Clever Care Health Plan Medicare Advantage Plan Overview

Name:Clever Care Value Medicare Advantage (HMO)
Plan ID:H7607 008 1
Provider:Clever Care Health Plan
Year:2023
Type:Local HMO
Combined Premium (C+D):$0/mo
Part C Premium:$0/mo
MOOP:$5,000/yr
Part D (Drug) Premium:$0/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$0/mo
Drug Deductible:$0/yr
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H7607-002




What type of plan is Clever Care Value Medicare Advantage (HMO)

Clever Care Value Medicare Advantage (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.



How much does Clever Care Value Medicare Advantage (HMO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Clever Care Health Plan charges a $0 consolidated premium. The Part C premium is $0 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Clever Care Value Medicare Advantage (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Clever Care Health Plan plan offers a $0 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Clever Care Health Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $0. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


Clever Care Health Plan Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Clever Care Health Plan plan does offer additional coverage through the gap.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Clever Care Value Medicare Advantage (HMO) by Clever Care Health Plan MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.



Formulary and Drug Coverage

Clever Care Value Medicare Advantage (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $10
Tier 3 NA $47
Tier 4 NA $99
Tier 5 NA 33%
Tier 6 NA $0

The complete Clever Care Value Medicare Advantage (HMO) Formulary.
*Initial Coverage Phase and 30 day supply






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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Clever Care Value Medicare Advantage (HMO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Clever Care Value Medicare Advantage (HMO) cost?

Clever Care Health Plan charges a $0 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Clever Care Value Medicare Advantage (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Clever Care Value Medicare Advantage (HMO) by Clever Care Health Plan MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services.

What type of plan is Clever Care Value Medicare Advantage (HMO)?

Clever Care Value Medicare Advantage (HMO) is a Local HMO. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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