Medicare Advantage-

Clover Health Choice (PPO) - 042

We've made a list of resources that may be helpful for you to use your new insurance coverage fully. 

Your Medicare Plan Details:

• Plan: You enrolled in a Medicare Advantage, Clover Health Choice (PPO) - 042
• Monthly Premium: $56.80 per month
• Network Details: This plan includes in-network and out-of-network benefits. Be advised that out-of-network doctors may have higher co-pays – check that the doctor will bill out of network before scheduling your appointment.

Helpful Links about your plan:

• Member Services Phone Number -  1-888-778-1478
• You can create an online account with your insurance to be able to access claims and plan information.
• Summary of Benefits reviews the more popular plan details and the Evidence of Coverage goes through the full details of the coverage.
• The Star Rating of your plan is 3 out of 5 stars
• If you'd like to appoint a representative to speak on your behalf.

Below are the online search tools to find IN-NETWORK healthcare providers:

• Doctor and Hospital
• Dentists
• Eve Care (Vision) Providers
• Hearing Aide Providers

 

Below are online search tools for your Prescription Drug Benefits:

• The Formulary has a complete list of medications covered by your insurance.
• Mail Orders Prescription option is available through CVS CareMark or by calling  1-888-778-1478.  
• In-Network Pharmacy Search

• There is a $150 deductible on Tier 2-5 prescriptions.  Below are pricing at a preferred pharmacy.
  • Tier 1 Preferred Generic- $0
  • Tier 2 Generic- $8
  • Tier 3 Prefered Brand- 25%
  • Tier 3 Insulin - $35 (no deductible)
  • Tier 4 Non-preferred Brand- 35%
  • Tier 5 Specialty- 31%

• In 2025 there is a $2,000 annual out of pocket maximum on covered medications. 
• There is a new Medicare Prescription Payment Plan (MPPP) option that allows you to spread your cost‑sharing over the remaining months of the plan year.  

Additional Benefits:

• Free gym membership is offered at participating gyms.  You can find gyms in your area with OnePass.
• Over-the-Counter Benefits and LiveHealthy Rewards - Your plan has $125 of over-the-counter benefits replenished every three months and additional money available with LiveHealthy Rewards.