2020 Clover Health Value (HMO) H8010-3-0 in NJ from Clover Health | HealthPocket

Clover Health Value (HMO)

$35/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderClover Health
Plan IDH8010-3-0
Plan Year2020
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$435.00
Out-of-Pocket Maximum6700

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Overview

Premium
Total monthly premium$35.50
Health plan premium$0.00
Drug plan premium$35.50
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$435.00
Estimated yearly costs
Estimated total yearly costs for care$4,032.00
Out-of-pocket max
Out-of-pocket max$6,700 In-network

Benefits & costs

Doctor services
Primary doctor visit$0 copay
Specialist visit$5 per visit
Tests, labs, & imaging
Diagnostic tests & procedures$0-150
Lab services$0 copay
Diagnostic radiology services (like MRI)$40-150
Outpatient x-rays$30
Emergency care$90 per visit (always covered)
Urgent care$40 per visit (always covered)
Hospital services
Inpatient hospital coverage$150 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage$190 per visit
Skilled nursing facility
Skilled nursing facility$0 per day for days 1 through 20
$178 per day for days 21 through 100
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$200
Therapy services
Occupational therapy visit$5
Physical therapy & speech & language therapy visit$5
Mental health services
Outpatient group therapy with a psychiatrist$5
Outpatient individual therapy with a psychiatrist$5
Outpatient group therapy visit$5
Outpatient individual therapy visit$5
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)20% per item
Prosthetics (like braces, artificial limbs)20% per item
Diabetes supplies$0 copay

Extra benefits & costs

Hearing
Hearing exam$5
Fitting/evaluationNot covered
Hearing aids - All types$699-999
Preventive dental
Oral exam$0 copay
Cleaning$0 copay
Fluoride treatment$0 copay
Dental x-rays$0 copay
Comprehensive dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative services$20
Endodontics$20
Periodontics$20
Extractions$20
Prosthodontics, other oral/maxillofacial surgery, other services$20
Vision
Routine eye exam$0 copay
Contact lenses$0 copay
Eyeglasses (frames & lenses)$0 copay
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Transportation services for non-emergency care: Any health-related locationsLimited coverage
Transportation services for non-emergency care: Plan-approved locationsNot covered
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Home and bathroom safety devicesNot covered
Meals for short durationNot covered
Annual physical examsLimited coverage
TelehealthLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs20%

Coverage Area for Clover Health Value (HMO)

StateNew Jersey
CountyOcean

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$12 copayNot offeredNot offered
Tier 2: Non-Preferred Generic22% coinsurance25% coinsuranceNot offeredNot offered
Tier 3: Preferred Brand Name22% coinsurance25% coinsuranceNot offeredNot offered
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsuranceNot offeredNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offeredNot offered
Tier 6: Select Care Drugs

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$24 copayNot offeredNot offered
Tier 2: Non-Preferred Generic22% coinsurance25% coinsuranceNot offeredNot offered
Tier 3: Preferred Brand Name22% coinsurance25% coinsuranceNot offeredNot offered
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsuranceNot offeredNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offeredNot offered
Tier 6: Select Care Drugs
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$36 copayNot offered$0 copay
Tier 2: Non-Preferred Generic22% coinsurance25% coinsuranceNot offered25% coinsurance
Tier 3: Preferred Brand Name22% coinsurance25% coinsuranceNot offered25% coinsurance
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsuranceNot offered25% coinsurance
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered25% coinsurance
Tier 6: Select Care Drugs

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screeningNot Rated
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical abilityNot Rated
Adult BMI assessmentNot Rated

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain assessmentNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye examNot Rated
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Improving bladder controlNot Rated
Medication reconciliation post-dischargeNot Rated
Plan all-cause readmissionsNot Rated
Statin Therapy for Patients with Cardiovascular DiseaseNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Rating of health care qualityNot Rated
Rating of health planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appealsNot Rated
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forwardNot Rated
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
Medication adherence for diabetes medicationsNot Rated
Medication adherence for hypertension - RAS antagonistsNot Rated
Medication adherence for cholesterol - StatinsNot Rated
MTM program completion rate for CMRNot Rated
Statin use in persons with diabetes - SUPDNot Rated

Physicians that accept Clover Health Value (HMO) for New Jersey

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).