Clover Health Medicare Advantage 2024 Review

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’s offerings have advantages and disadvantages.

• 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. 

• 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.

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^[0]

For comparison, the average star rating for plans from all providers is 4.04^[0]

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

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^[0]

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^[0]

, 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.)

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.

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:

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^[0]