General Costs
Monthly Premium
$42.40
Maximum Out-of-Pocket
$12,999
Cost to see your Doctor*
See your primary care doctor or a specialist as often as you need to.
Primary Care Visit
$0
Specialist Visit
$5
Vision copay
$5
Dental copay
$5
Hearing copay
$5
Prescription Costs
Prices are for a 30-day supply from an in-network pharmacy.
Tier 1
$0
Tier 2
$8
Tier 3
23%
Tier 4
34%
Tier 5
25%
Prescription drug deductibles
$545 for tiers 2-5
Hospital Costs
Inpatient hospital care*
$375 a day (days 1-6)
$0 a day (days 7-90)
Outpatient surgery*
$300
Emergency room
$100
Ambulance*
$350
Extra benefits and services
Clover plans include these important benefits and services. Original Medicare doesn't.
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SilverSneakers®
Get access to over 17,000 fitness centers
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OTC
You get a quarterly allowance for select OTC items.
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24/7 doctor visits
Speak to a board-certified doctor by phone, web, or mobile app.
*Values shown are representative of In-network costs only. Out-of-network providers may charge a different member cost-share. Out-of-network/non-contracted providers are under no obligation to treat Clover members, except in emergency situations.