Clover Health

Happy to help! We need a little more information to answer this question for you. Please give us a call at 1-888-778-1478. Thank you!

I'm so sorry to hear that, Bridget, that is extremely frustrating. Please try giving us a call at 1-800-836-6890. You can also always send us a private message on Facebook with your information and we'll get in touch with you. We're happy to help and answer any questions you have!

Hi Rose! Give our member experience team a call at 1-888-778-1478 and they can take a look at your plan with you and let you know if anything has changed.

Hi Amarjit, it looks like our Member Services team reached out to you to assist with this. Please let us know if you have any other questions.

Providers that are out-of-network are not required by law to accept Clover Health members, and it's up to the provider whether they want to see Clover Health members and whether or not they want to bill Clover Health. Call us anytime to see if a provider is willing to have a billing relationship with Clover Health, or to find a doctor who accepts our members. We're happy to reach out to any provider on your behalf to see if they'll accept Clover Health.

Yes. You can use your LIS with any of our plans, but our New Jersey Value plans (available in some counties) are designed to coordinate with the benefits you're entitled to with LIS.

Clover Health has plans in the following counties: Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset, Sussex, Union, and Warren. For information, visit our Plans page. https://www.cloverhealth.com/plans

You can purchase a Medicare Supplement Insurance (Medigap) plan in addition to Original Medicare to fill the gaps not covered by Medicare alone. A Medigap plan is different from a Medicare Advantage plan. Generally, people with Medigap plans can see any doctor they want, so they are not limited to a particular insurance plan’s network. Medigap plans do not include prescription drug coverage. For prescription drug coverage, a separate Medicare Part D drug plan must be purchased.

You can find a doctor who accepts Medicare by visiting Medicare.gov to search for covered physicians and other clinicians. If you’re a member of Clover Health, find an in-network doctor, pharmacy, and supplemental benefits through cloverhealth.com.

Original Medicare consists of Part A and Part B. Part A is hospital coverage, and Part B is medical coverage. Most Medicare beneficiaries pay a premium for Part B coverage.

You can enroll in Medicare Part A and/or Medicare Part B online at SocialSecurity.gov, over the phone by calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778) 7 am–7 pm Monday through Friday, or in person at your local Social Security office.

As explained on the Health and Human Services website, generally Medicare is available for people age 65 or older, younger people with disabilities, and people with end-stage renal disease, or ESRD (permanent kidney failure requiring dialysis or transplant). Medicare includes Part A (hospital insurance) and Part B (medical insurance). You are eligible for premium-free Part A if you are 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if: You are receiving retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them. You or your spouse had Medicare-covered government employment.

If you are under 65 years old and you or your spouse did not work at least 10 years for which you paid Medicare taxes, you may not be eligible for Medicare. For more information on eligibility, please visit the U.S. Department of Health & Human Services Medicare eligibility page, and to test your own eligibility, visit the Medicare.gov Eligibility & Premium Calculator.

The Annual Election Period, October 15th to December 7th, is your yearly opportunity to compare your options and choose a Medicare Advantage plan that best meets your needs and budget. To help get you started, here are some things to consider: Does the plan offer a $0 monthly premium? Are the doctors and specialists that you see included in the plan’s network? Does the plan formulary include your prescription drug?

Most Medicare Advantage plans try to include a $0 premium plan, but costs vary from plan to plan, service area to service area.

You can choose a Medicare Advantage plan (Medicare Part C) to provide all of the benefits you are entitled to under Medicare—plus extra benefits. Most Medicare Advantage plans include Medicare Part D prescription drug coverage. Medicare Advantage plans, such as Clover Health, provide these benefits through a contract with the government. With a Medicare Advantage plan, you may have to pay more if you see a doctor or provider who is not in the plan’s network. However, with a Medicare Advantage plan, there will be an annual limit to the out-of-pocket costs you pay.

HMO stands for health maintenance organization. HMO has a narrower network than PPO insurance and is usually referral-based. Members typically are required to go to a primary care physician (PCP) first and then be referred to specialists, most likely in their network. Because of the limitations of the network covered, HMO insurance is typically a lower cost plan.

PPO stands for preferred provider organization. PPO insurance includes a more open network, giving the member more healthcare providers to choose from, and typically any provider that accepts Medicare will accept the PPO insurance. Members usually pay a slightly higher premium, higher cost shares, and a higher deductible with a PPO plan.

One of the biggest differences between an HMO and a PPO plan is that in an HMO you are restricted to using network providers, except for in emergency situations. In a PPO, you are not restricted to using network providers. We continue to offer both traditional and non-traditional PPO plans. In NJ and TX, we also offer HMO plans. PPO: Clover Health will reimburse any provider who participates in Medicare and bills Clover Health for Medicare-covered services. In most PPO plans, members have different shares of cost in and out of network, usually with lower costs in network. In some of our PPO plans, members have the same shares of cost in and out of network. HMO: Clover Health will pay only for services received in network. Members have a fixed share of cost for in-network services. These plans have no coverage out of network—except for in cases of emergent or urgent care, ambulance, post-stabilization care, and dialysis services. Members will not need a referral to see a specialist or have a procedure with our HMO plans, but every service or item they receive must be in network.

Medicare is a federal health insurance program that provides coverage for more than 55 million people with a variety of needs and circumstances. Medicare covers people who are 65 and over, have end-stage renal disease (ESRD), and/or have qualifying disabilities and have received Social Security benefits for more than one year.

You are eligible to apply for Medicare 3 months prior to the month you turn 65 and the month you turn 65. If you don't apply for Medicare within 3 months of turning 65, you'll have to wait for the next enrollment period to apply.

If you're 65 or over (or turning 65 in the next 3 months) and not already getting benefits from Social Security, you need to sign up to get Medicare Part A (hospital insurance) and Part B (medical insurance). Part B is optional for Original Medicare; however, it is required when you apply for a Medicare Advantage plan. You can sign up for Medicare online or contact Social Security. Social Security will then review your records to see if you qualify for Medicare.

Hi Dominic, as explained on the Health and Human Services website, generally Medicare is available for people age 65 or older, younger people with disabilities, and people with end-stage renal disease, or ESRD (permanent kidney failure requiring dialysis or transplant). Give our team a call at 1-800-836-6890 if you have any questions about eligibility, we're happy to help!

Hi Marcy! We're happy to help you find a dentist near you, just give us a call at 1-888-778-1478.

Clover has mailed all welcome packs and ID cards for 2021. However, due to circumstances beyond our control with the United States Postal Service, shipping may be delayed. You can still seek medical care and fill your prescriptions without your membership card.

Hi Karen! You don't have to transfer them; however, some pharmacies are part of a preferred network and may provide medications at a lower cost for certain plans. Search your plan’s pharmacy directory here to find a network pharmacy near you: https://www.cloverhealth.com/en/members/find-pharmacy

Hi Debbie! Thank you so much for being a member. We are currently in 7 states in 2020, and will be in 8 in 2021, but unfortunately we do not yet service Ohio. I'm so sorry for the inconvenience, and please give us a call if there's anything we can do to help make the transition easier for you.

Hi! You can use the DentaQuest website to find a dentist near you that accepts Clover Health insurance: http://dentaquest.com/find-a-provider/cloverdental/. If you still have questions, feel free to give us a call anytime. We're here to help!

Hi Ann, I'm so sorry to hear that. To discuss information regarding approved services, please contact 1-800-421-7592. Please let me know if there's anything else I can do to help. Wishing you all the best.

If you call member services at 1-888-778-1478 (TTY 711), we should be able to resolve these issues for you.

Costs varies by plan. Visit cloverhealth.com/plans to learn about the specific benefits of each plan, and their cost.

We're not currently available in New York.

Clover Health works with EyeQuest to provide our prescription coverage. Visit the following link to find a provider near you: https://govservices10.dentaquest.com/Router.jsp?component=Main&source=Logon&action=ProviderDirectory

You can use the DentaQuest website to find a dentist near you that accepts Clover Health insurance: http://dentaquest.com/find-a-provider/cloverdental/

Dental coverage varies by plan. Visit cloverhealth.com/plans to learn about the specific benefits of each plan.

Either give us a call at 1-800-836-6890 (TTY 711), visit our website at cloverhealth.com, or talk to your local insurance broker to see if you're eligible for Clover Health's Medicare Advantage plans.