Clover Health Medicare Advantage 2024 Review

Clover Health Medicare Advantage plans are available in five states and get below-average star ratings from CMS.
Kate Ashford, CSA®
By Kate Ashford, CSA® 
Published
Edited by Holly Carey

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Clover Health - Medicare Advantage - Chapter

Clover Health

3

CMS Star Rating

Clover Health sells mostly PPO plans in five states but gets below-average star ratings from CMS.

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from askchapter.org

States available

5 states


Members in high-rated plans

Low (49% or less)


Member experience

2.47 (Below average)


States available

5 states


Members in high-rated plans

Low (49% or less)


Member experience

2.47 (Below average)


Pros

  • Mostly PPO plans, which are more flexible than HMOs.
  • Two-thirds of plans offer a $0 premium.

Cons

  • Star ratings are below the industry average.
  • Member experience ratings are below the average for major providers.
  • Average out-of-pocket maximums are higher than those of major providers.

Clover Health Medicare Advantage plans are available in five states, and the provider’s star ratings from the Centers for Medicare & Medicaid Services (CMS) are below average. Member experience ratings are also below the average for major providers.

Here’s what you should know about Clover Health Medicare Advantage.

Clover Health Medicare Advantage pros and cons

Clover Health’s offerings have advantages and disadvantages.

Pros

  • Mostly PPO plans: Most of Clover Health’s Medicare Advantage plans are PPO plans, which offer more flexibility than HMOs. 

  • $0 plans: Two-thirds of Clover Health Medicare Advantage plans offer a $0 premium. 

Cons

  • Below-average star ratings: Clover Health Medicare Advantage plans score a lower-than-average star rating from CMS — 3.00 for 2024 plans, versus 4.04 for the industry as a whole.

  • High out-of-pocket max: Clover Health’s average out-of-pocket maximum — the most you would be responsible for paying in a plan year — is higher than those of the major providers at about $7,800. 

  • Subpar member experience ratings: Clover Health’s average member ratings on metrics like customer service and getting needed care are below the average for major providers. 

  • Limited availability: Clover Health offers Medicare Advantage plans in just five states.

Clover Health Medicare star ratings

Average star rating, weighted by enrollment: 3

The Centers for Medicare & Medicaid Services maintains star ratings for Medicare Advantage plans on a 5-point scale, ranking plans from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data and weighted by enrollment, Clover Health’s 2024 Medicare Advantage plans get an average rating of 3 stars

Centers for Medicare & Medicaid Services. 2024 Star Ratings Data Tables (Oct 13 2023) (ZIP). Accessed Jan 8, 2024.
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For comparison, the average star rating for plans from all providers is 4.04

Centers for Medicare & Medicaid Services. 10.13.23 Fact Sheet - 2024 Medicare Advantage and Part D Ratings (PDF). Accessed Jan 8, 2024.
.

You can find a plan’s rating with the Medicare plan finding tool.

What does Clover Health Medicare Advantage cost?

Costs for Medicare Advantage plans depend on your plan, your geographic location and your health needs.

Premiums

One of the costs to consider is the plan’s premium. In 2024, about two-thirds of Clover Health Medicare Advantage plans (67%) have a $0 premium

Centers for Medicare & Medicaid Services. CY2024_Landscape_Files_Final_20231005 (ZIP). Accessed Jan 8, 2024.
.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $174.70 per month in 2024

Centers for Medicare & Medicaid Services. Costs. Accessed Jan 8, 2024.
, although some plans cover part or all of this cost. (Most people pay this standard amount, but if your income is above a certain threshold, you'll pay more.)

Copays, coinsurance and deductibles

Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

  • Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s plan-finding tool to compare information among available plans in your area. You can select by insurance carrier to see only Clover Health plans or compare across carriers. You can also shop directly from Clover Health’s website by entering your ZIP code.

Available Medicare Advantage plans

There are a few kinds of Clover Health Medicare Advantage plans, and they vary in terms of structure, costs and benefits. Clover Health offers Medicare Advantage prescription drug plans (MAPDs) as well as Medicare Advantage plans without drug coverage.

Plan offerings include the following types:

A health maintenance organization (HMO) generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

Preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

Clover Health Medicare Advantage service area

Clover Health offers Medicare Advantage plans in five states: Georgia, New Jersey, Pennsylvania, South Carolina and Texas — down from eight states in 2023. Clover Health covers more than 80,000 Medicare Advantage beneficiaries

Centers for Medicare & Medicaid Services. Monthly Enrollment by Contract. Accessed Jan 8, 2024.
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Compare Medicare Advantage providers

Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

Find the right Medicare Advantage plan

It’s important to do your research before selecting a Medicare Advantage plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

Still deciding on the right carrier? Compare Medicare Advantage plans

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