Compare Clover Health Medicare Advantage Plan Options

This page explains how Clover Health Medicare plans work, what to check before you enroll, and how Clover Health Medicare plans compare with everything else available in your county. We are an independent agency, not the carrier.

Understanding Clover Health Medicare plans

Clover Health is a Medicare Advantage organization. Its 2026 provider manual and broker materials identify plan activity in Georgia, New Jersey, Pennsylvania, South Carolina and Texas. The carrier's plan finder begins with a ZIP-code search and asks the user to select a county when a ZIP crosses county lines.

That county step is more than a website convenience. Medicare Advantage plans have CMS-approved service areas. Moving across a county line can change which plans are available, even when the new home is nearby.

Clover's current materials primarily describe PPO coverage, although a 2026 HMO Annual Notice of Change also documents an HMO plan in an applicable market. Do not assume the same plan structure is offered in all five states. A licensed O'Neal Insurance Group agent can help you compare companies and plans currently available in your ZIP code and county.

Useful Clover facts

• Clover is a Medicare Advantage carrier, not Original Medicare.
• Current 2026 materials identify select counties in GA, NJ, PA, SC and TX.
• The carrier's plan finder requires a ZIP code and county.
• PPO does not mean every out-of-network provider must accept the plan.
• Current sources used here do not establish Clover Medigap, standalone PDP or SNP products.

Clover products and state availability

Comparing Clover Health Medicare plans

Clover PPO considerations

A PPO generally permits members to receive covered services from in-network and qualifying out-of-network providers. Members usually pay less in network. Out-of-network providers may not be obligated to treat a Clover member for routine non-emergency care, and plan payment does not guarantee the provider will accept the arrangement.

Ask each physician or facility about the exact Clover plan. A receptionist saying “we take Medicare” may mean Original Medicare, not Clover Medicare Advantage. Also confirm whether the provider is accepting new patients.

The plan's maximum out-of-pocket limit applies to covered Parts A and B services under its rules. Prescription drug expenses follow the plan's Part D structure. Review deductibles, copayments, coinsurance and prior authorization rather than comparing premium alone.

Clover HMO considerations

An HMO generally requires use of a contracted network except for emergency, urgent and other defined care. A primary care provider may coordinate services, and referrals or prior authorization can apply.

Because Clover's HMO footprint is not established as identical to its PPO footprint, verify the contract number, plan ID and county. Never use a plan document from one state as proof of an HMO in another.

Prescription drug coverage

Many Medicare Advantage plans include Part D and are called MAPD plans. Check whether the exact Clover plan includes drug coverage. Then review each medication's name, dosage, frequency, tier, authorization, quantity limit and step-therapy requirements.

Pharmacy networks matter too. A preferred pharmacy may offer different cost sharing than a standard network pharmacy. Formularies can change under Medicare rules, so annual review is valuable.

Special Needs Plans and government assistance

Current primary sources reviewed for this page do not establish a 2026 Clover D-SNP, C-SNP or I-SNP. Do not add those products merely because Clover serves counties with dual-eligible or chronically ill residents.

A D-SNP requires Medicare, qualifying Medicaid and county availability. A C-SNP requires a qualifying condition and verification. An I-SNP has institutional or equivalent requirements. Consumers interested in SNPs should compare Medicare-approved carriers currently offering them in the county.

Medicaid and Medicare Savings Programs are administered by the applicable state agency. Extra Help—also called LIS—is a federal Part D assistance program. These are not Clover supplemental benefits, and an agent does not decide eligibility.

Part B reductions, flex cards and additional benefits

Clover plans may include plan-specific OTC, dental, vision, hearing, fitness or reward features. The current Summary of Benefits must support every promoted feature.

A Part B premium reduction, if offered by a specific plan, lowers what a member pays toward Part B. It is not cash. A flex or allowance feature has approved expenses, participating merchants and usage rules.

Part B premium reductions, flex cards, and other supplemental benefits are not included with every Medicare Advantage plan. Availability, eligibility, benefit amounts, approved expenses, and participating locations vary by plan and service area.

Clover plans and veterans

VA health care, TRICARE and Medicare are separate. Joining Clover does not replace or enroll someone in VA benefits. Veterans should compare non-VA doctors, prescriptions, urgent care, emergencies and prior authorization.

If a Clover plan includes Part D, consider how it would be used alongside VA prescription benefits. People with TRICARE for Life should ask TRICARE before enrolling in coverage that may affect coordination.

How a licensed agent narrows Clover Health Medicare plans

A licensed agent can help you:

• Verify Clover service in the county
• Compare available PPO or documented HMO choices
• Check doctors, hospitals and pharmacies
• Review prescriptions and formulary rules
• Compare premiums, cost sharing and maximum out-of-pocket limits
• Explain plan-specific benefits and restrictions
• Review official plan documents
• Submit an enrollment application after you decide

The agent cannot determine Medicaid, Extra Help or SNP eligibility.

Seven steps for comparing Clover Health Medicare plans

1. Confirm Medicare Parts A and B and the enrollment period.
2. Determine whether Medicaid, a Savings Program or Extra Help may be relevant.
3. Enter the permanent ZIP code and select the correct county.
4. List doctors, hospitals, pharmacies and prescriptions.
5. Identify VA, TRICARE, employer or union coverage.
6. Review networks, formularies, costs, authorizations and benefits.
7. Read the official Summary of Benefits and Evidence of Coverage before applying.

Frequently asked questions

How to compare Clover Health Medicare plans against the alternatives

No carrier is the right answer for everybody, and that includes Clover Health Medicare plans. What decides it is your own doctors, your own prescriptions and how you prefer to pay, in that order.

Start with your providers. Check every physician you want to keep against the plan directory, and confirm the medical group as well as the individual name. That single step rules Clover Health Medicare plans in or out faster than any brochure will.

Then price your prescriptions. Two plans with an identical premium can differ by thousands of dollars a year once your real drug list is run against each formulary. Ask specifically about tiers, step therapy and prior authorization.

Then look at the ceiling, not the premium. Every Medicare Advantage plan carries an annual out-of-pocket maximum; Original Medicare on its own does not. That ceiling is the real protection, and it varies by thousands of dollars between plans.

Commissions are set by the Centers for Medicare & Medicaid Services and are identical across carriers for the same product line. An independent agent comparing Clover Health Medicare plans with everything else available in your county therefore has no financial reason to favor one over another.

What 2026 changes for Clover Health Medicare plans

Two federal rules apply to every Part D policy this year, Clover Health Medicare plans included, whether standalone or bundled inside a Medicare Advantage plan. No plan may charge a drug deductible above $615, and once you have spent $2,100 out of pocket on covered drugs your cost for the rest of the calendar year drops to zero.

The Medicare Prescription Payment Plan lets you spread that $2,100 across monthly installments instead of facing a large bill in January. It is worth asking about if your medications are expensive early in the year.

What still changes annually is the detail: networks, formularies, copays and supplemental benefits. The Annual Notice of Change your carrier sends by September 30 is where those changes are disclosed, and it is the document to read before deciding whether to keep Clover Health Medicare plans for another year.

Enrollment windows that apply to Clover Health Medicare plans

The windows below govern Clover Health Medicare plans exactly as they govern every other Medicare Advantage and Part D plan. They are federal, not carrier-specific, and no salesperson can extend one for you.

Initial Enrollment Period. Seven months centred on the month you turn 65 — the three months before, the birthday month itself, and the three months after. Part B and Part D late penalties are permanent, so this is the window that costs money to miss.

Annual Enrollment, October 15 to December 7. Open to everyone on Medicare. Whatever you choose takes effect on January 1.

Medicare Advantage Open Enrollment, January 1 to March 31. One change only, and only if you are already enrolled in an Advantage plan.

Special Enrollment Periods. Moving out of a plan’s service area, losing employer coverage, entering or leaving a nursing home, or gaining or losing Medicaid each open a window outside the normal calendar.

How Clover Health Medicare plans differ from the rest of the market

Two things set this carrier apart, and both are worth understanding before you compare.

The first is network philosophy. Most of the industry has moved toward narrower HMO networks; Clover Health Medicare plans have stayed deliberately PPO-heavy, which generally means more freedom to see providers outside a closed panel, usually at a different cost share. If keeping a particular specialist matters more to you than the lowest possible copay, that design is the reason to look here.

The second is the Clover Assistant, software the company supplies to network physicians to surface gaps in care during the visit itself. It is a clinical model rather than a benefit, so it will not appear on any benefits chart — but it is the substance behind the company’s quality claims.

Two practical notes. Clover Health Medicare plans are Medicare Advantage only: there is no standalone Part D plan and no Medicare Supplement policy. And the 2026 footprint is five states — Georgia, New Jersey, Pennsylvania, South Carolina and Texas — across roughly 200 counties, so availability is genuinely local rather than national.

Medicare reference charts

One more chart that answers a question we get constantly.

Check Clover Health Medicare plans independently

Never take an agency’s word for how a carrier performs, including ours and including anything we say about Clover Health Medicare plans. Each of these sources is free and sells nothing.

• Medicare.gov Plan Compare — every plan sold in your ZIP code, with star ratings and your prescriptions priced in
• SHIP National Technical Assistance Center — free one-to-one counseling in your state
• Social Security Administration — Extra Help with prescription drug costs
• National Association of Insurance Commissioners — carrier complaint records and agent license lookup

Related guides on this site

• Medicare Simplified — the full guide for anyone new to Medicare
• What Medicare Advantage costs and how Medigap works
• The five Medicare deadlines that matter
• Every carrier we compare
• Book a no-cost appointment

Or call (877) 808-2900 and we will compare Clover Health Medicare plans against every other plan available in your county, at no cost and with no obligation.

Required disclosures

Not all carriers, products, benefits, or plans represented by O'Neal Insurance Group are available in every state, county, ZIP code, or service area. Plan availability and benefits may change each plan year. Please call or contact us to learn more about the options currently available in your area.

O'Neal Insurance Group is not connected with or endorsed by the United States government, the federal Medicare program, any state Medicaid program, the Department of Veterans Affairs, or any insurance carrier.

We do not offer every plan available in your area. Currently we represent 30 organizations which offer over 125 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.