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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® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 18 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
Many or all of the products featured here are from our partners who compensate us. This influences which products we write about and where and how the product appears on a page. However, this does not influence our evaluations. Our opinions are our own. Here is a list of our partners and here's how we make money.
Clover Health
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CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Clover Health sells mostly PPO plans in five states but gets below-average star ratings from CMS.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Low (49% or less)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.45 (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.
States available
5 states
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Low (49% or less)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.45 (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
Star ratings: Clover Health Medicare Advantage plans score a lower-than-average star rating from CMS.
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.
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.
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
, 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.
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:
HMO plans
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.
PPO plans
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 nearly 80,000 Medicare Advantage beneficiaries
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.
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).
