The bottom line: Clover Health Medicare Advantage plans are mostly PPOs, which can allow more flexibility than HMOs to choose your healthcare providers. Most of Clover Health's plans have $0 premiums, but the out-of-pocket maximums can be high and their government quality ratings could be better. Jump to: Full Review
Clover Health Medicare Advantage pros and cons
Pros
- Mostly PPO plans: Most of Clover Health’s Medicare Advantage plans are PPO plans, which offer more flexibility than HMOs.
- $0 plans: Nearly 70% of Clover Health Medicare Advantage plans offer a $0 premium.
Cons
- Quality ratings: Clover Health gets below-average quality ratings from the Centers for Medicare & Medicaid Services (CMS) for 2026.
- Out-of-pocket max: Clover Health’s average out-of-pocket maximum — the cap on your copays, coinsurance and deductibles — is much higher than average among companies NerdWallet analyzed.
- Problems with care and coverage: Clover Health members who left their plan identified higher-than-average numbers of problems getting their plans to pay for care and with coverage of doctors and hospitals.
Compare against other providers
🔍 UnitedHealthcare Medicare Advantage
» More options in our roundup of the best Medicare Advantage plans
Compare against other providers
🔍 UnitedHealthcare Medicare Advantage
» More options in our roundup of the best Medicare Advantage plans
Our full review
NerdWallet star rating for Clover Health Medicare Advantage
Clover Health Medicare Advantage plans earned 3.3 out of 5 stars for overall performance. NerdWallet’s ratings are determined by our editorial team. The scoring formula takes into account premiums, out-of-pocket costs, government quality ratings, customer complaints, disenrollment survey data, third party quality accreditation and more.
NerdWallet star ratings are different from CMS ratings for Medicare plans.
Our data-driven, consumer-first scoring rubric for Medicare Advantage plans includes crucial metrics like cost and a wider range of data sources for quality and customer satisfaction in addition to the information incorporated into CMS ratings.
45+ Medicare companies and brands analyzed by our team of experts.
30+ years of combined experience covering Medicare and personal finance.
Governed by NerdWallet's strict guidelines for editorial integrity.
NerdWallet’s Medicare content, including articles, reviews and recommendations, is produced by a team of writers and editors who specialize in Medicare. Their work has appeared in The Associated Press, Washington Post, Nasdaq, MSN, MarketWatch, Yahoo! Finance and other national and regional media outlets. They have been cited in publications including Healthline, and appeared on NerdWallet's "Smart Money" podcast.
Government quality ratings for Clover Health Medicare Advantage
Average CMS star rating, weighted by enrollment: 3.51
Clover Health Medicare Advantage plans are rated below the industry average, receiving an average quality rating of 3.51 stars out of 5 from the Centers for Medicare & Medicaid Services (CMS) for 2026, weighted by enrollment. For comparison, the average weighted CMS star rating for all companies is 4.02.
Of Clover Health members who are in Medicare Advantage plans with a star rating, 2% are in plans that have been rated 4 stars or above for 2026.
CMS maintains its own database of star ratings, which rank each plan 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.
All Medicare Advantage plans are evaluated on health plan measures, and Medicare Advantage plans that include prescription drug coverage are also evaluated on drug plan measures.
You can find a plan’s rating with Medicare's plan finding tool.
How much does Clover Health Medicare Advantage cost?
Premiums
About 69% of Clover Health Medicare Advantage plans have a $0 premium.
Clover plans with a premium cost about $33.46 per month, on average, weighted by enrollment.
With any Medicare Advantage plan, you’ll also be responsible for paying your Medicare Part B premium, which is at least $202.90 per month in 2026.
Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay the income-related monthly adjustment amount (IRMAA). Some Medicare Advantage plans pay some or all of your Part B premium.
Prescription drugs
About 81% of Clover Health Medicare Advantage plans include prescription drug coverage.
Here’s what you might pay for prescription drugs at some common price points.
Tier 1 (Preferred generics) 100% of Clover Medicare Advantage plans have $0 copays/coinsurance.
$0: Out-of-pocket cost for all Tier 1 drugs among Clover Medicare Advantage plans (after deductible, if any).
Tier 2 (Most generics) 3.5% of Clover Medicare Advantage plans have $0 copays/coinsurance.
$6.24: Average out-of-pocket cost for a drug with a $50 retail price, among Clover plans with copays or coinsurance at Tier 2 (after deductible, if any).
Tier 3 (Preferred brands) None of Clover's Medicare Advantage plans have $0 copays/coinsurance.
$47.11: Average out-of-pocket cost for a drug with a $200 retail price, among Clover plans with copays or coinsurance at Tier 3 (after deductible, if any).
Other out-of-pocket costs
Clover Medicare Advantage plans have an average maximum out-of-pocket (MOOP) spending cap of $8,519, weighted by enrollment. That’s considerably higher than average among the companies NerdWallet reviews.
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 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 whether the plan charges for them.
To get a sense of costs, Medicare.gov and most other Medicare shopping tools can help you compare plans' premiums and out-of-pocket costs for certain services and prescription drugs in your location.
Why do people leave Clover Health Medicare Advantage plans?
CMS surveys people who voluntarily leave their Medicare plans about their reasons for leaving. Here’s the breakdown of problems people identified with their former Clover Medicare plans.
Problems getting covered care: 19% (All-company average: 11%).
Problems with doctor/hospital networks: 28% (All-company average: 17%).
Financial issues: 21% (All-company average: 17%).
Problems with prescription drug benefits: No data available (All-company average: 3%).
Problems getting information from the plan: 17% (All-company average: 9%).
(Members can give more than one reason for leaving on the survey and might leave plans for other reasons, so the categories won’t add up to 100%.)
Clover Health Medicare Advantage plan types
Clover Health offers Medicare Advantage prescription drug plans and Medicare Advantage plans without prescription drug coverage. Nearly all of its plans are PPOs.
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.
Clover Health covers over 155,000 Medicare Advantage beneficiaries.
Compare Medicare Advantage companies
Get more information below about some of the major Medicare Advantage insurance companies. 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 preferred medical 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).
- PPO plans offer more flexibility than HMOs.
- The majority of Clover Health plans have $0 premiums.
- Government quality ratings are below average.
- Out-of-pocket maximums can be high.
- Available only in five states.
NerdWallet writers are subject matter authorities who use primary, trustworthy sources to inform their work, including peer-reviewed studies, government websites, academic research and interviews with industry experts. All content is fact-checked for accuracy, timeliness and relevance. You can learn more about NerdWallet's high standards for journalism by reading our editorial guidelines.
- 1.NerdWallet analysis of CMS data. 2026 Star Ratings Data Tables. Accessed Apr 28, 2026.
- 2.NerdWallet analysis of CMS data. Monthly Enrollment by Plan. Accessed Apr 28, 2026.
- 3.NerdWallet analysis of CMS data. CY2026 Landscape 202603. Accessed Apr 28, 2026.
- 4.Centers for Medicare & Medicaid Services. Understanding Medicare Advantage Plans. Accessed Apr 28, 2026.
- 5.NerdWallet analysis of CMS data. Beneficiary Cost File. Accessed Apr 28, 2026.
- 6.NerdWallet analysis of CMS data. 2026 Star Ratings Data Table - Disenrollment Reasons (Oct 8 2025). Accessed Apr 28, 2026.
Medicare Advantage review methodology
NerdWallet’s Medicare Advantage ratings are based on premiums, out-of-pocket costs, prescription drug coverage, quality data from the Centers for Medicare & Medicaid Services, consumer experience and more. We calculate each health insurance company’s rating on a curved 5-point scale.
NerdWallet’s editorial team analyzed companies covering about 87% of all Medicare Advantage beneficiaries in the United States. We reviewed 25 Medicare Advantage brands, with some insurance companies having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.)
The Medicare Advantage marketplace is concentrated among just a handful of companies. In many places, one company serves more than half of the market. At the national level, NerdWallet’s reviews include each of the 10 largest brands by enrollment.
At the state level, our research includes at least one major insurer in every state where Medicare Advantage plans are sold, and includes the top two insurers in 40 of those 49 states. (Alaska doesn't offer Medicare Advantage plans.) We also look at online search volume to identify regional and other notable players in the space.
These reviews are a guide, but we encourage you to shop around and compare several plans to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for additional information.
Compare Medicare Advantage plans
Insurance company | CMS star rating | States available | Members in high-rated plans | Member experience | Learn more | |
|---|---|---|---|---|---|---|
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 4.11 | 4.11/5 | 48 states and Washington, D.C. | Medium (50% to 84%) | 3.74 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 3.79 | 3.79/5 | 46 states and Washington, D.C. | Low (49% or less) | 3.82 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on http://askchapter.org on NerdWallet | 4.20 | 4.20/5 | 43 states and Washington, D.C. | Medium (50% to 84%) | 3.89 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on http://askchapter.org on NerdWallet |
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 3.76 | 3.76/5 | 29 states and Washington, D.C. | Medium (50% to 84%) | 3.96 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |