Clover Health Valor (PPO) Medicare Advantage Plan H5141-062 • 2027
CMS Rating:
(5.0 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6500.00In-network
- Part B Giveback
- −$150.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 50 beneficiaries
Last update:
Clover Health Valor (PPO) Introduction
CMS Plan ID H5141-062 identifies Clover Health Valor, a Medicare Advantage PPO plan offered by Clover Health. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $6500.00 in-network maximum out-of-pocket.
Plan Benefits
Clover Health Valor has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5141-062.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Specialist | In-network: $45 copay Out-of-network: $65 copay |
In-network: $45 copay Out-of-network: $65 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$45 copay | In-network: $0-$45 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $50-$250 copay Out-of-network: 30% coinsurance |
In-network: $50-$250 copay Out-of-network: 30% coinsurance |
| Lab services | In-network: $0-$30 copay Out-of-network: $50 copay |
In-network: $0-$20 copay Out-of-network: $40 copay |
| Outpatient x-rays | In-network: $40 copay Out-of-network: 30% coinsurance |
In-network: $40 copay Out-of-network: 30% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$250 copay Out-of-network: 0%-30% coinsurance |
In-network: $0-$250 copay Out-of-network: 0%-30% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $130 copay |
| Worldwide emergency care | Coming soon | $130 copay |
| Urgent care | $25 copay | $25 copay |
| Inpatient hospital care | In-network: Tier 1 $405 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $555 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $399 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $595 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: 40% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 40% per stay |
| Ground ambulance | In-network: $350 copay Out-of-network: $350 copay |
In-network: $350 copay Out-of-network: $350 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $45 copay Out-of-network: 30% coinsurance |
In-network: $45 copay Out-of-network: 30% coinsurance |
| Outpatient group therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $405 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $555 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $399 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: $595 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
| Occupational therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 15% coinsurance Out-of-network: 20% coinsurance |
In-network: 15% coinsurance Out-of-network: 20% coinsurance |
| Durable medical equipment | In-network: 15% coinsurance Out-of-network: 20% coinsurance |
In-network: 15% coinsurance Out-of-network: 20% coinsurance |
| Prosthetics | In-network: 15% coinsurance Out-of-network: 20% coinsurance |
In-network: 15% coinsurance Out-of-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Periodontics | In-network: $20 copay Out-of-network: 50% coinsurance |
In-network: $20 copay Out-of-network: $40 copay |
| Endodontics | In-network: $20 copay Out-of-network: 50% coinsurance |
In-network: $20 copay Out-of-network: $40 copay |
| Restorative services | In-network: $20 copay Out-of-network: 50% coinsurance |
In-network: $20 copay Out-of-network: $40 copay |
| Implant services | In-network: $20 copay Out-of-network: 50% coinsurance |
In-network: $20 copay Out-of-network: $40 copay |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $20 copay Out-of-network: 50% coinsurance |
In-network: $20 copay Out-of-network: $40 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids | In-network: $499-$999 copay Out-of-network: $5000 copay |
In-network: $499-$999 copay Out-of-network: $5000 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Clover Health Valor as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H5141)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Clover Health
- Website
- Clover Health Plan Page
- Providers
- Clover Health Providers Page
- Formulary
- Clover Health Formulary Page
- Pharmacy
- Clover Health Pharmacy Page
- New Member Health Plan Help
- (888)466-5044
- New Member Health Plan TTY
- 771
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Clover Health Valor (H5141-062-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Clover Health Valor (PPO)
How much does plan H5141-062 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $6500.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the current enrollment for Clover Health Valor?
The plan has 50 enrolled beneficiaries according to CMS.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Clover Health (official source) | http://www.cloverhealth.com | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.