clover health medicare review — Clover Health is a technology-driven Medicare Advantage insurer founded in 2014. The company went public on the NASDAQ in January 2021 under the ticker symbol CLOV. It is headquartered in Franklin, Tennessee, with offices in Jersey City and San Francisco. Clover Health stands out by integrating artificial intelligence into its care delivery model.
- Clover Health Overview and Financial Strength
- Clover Health Medicare Review: Medicare Plan Options
- Clover Health Medicare Rates and Enrollment
- Clover Health Additional Benefits and Perks
- Clover Health Claims Process and Customer Service
- Pros and Cons of Clover Health Medicare Plans
- Who Is Clover Health Best For?
- Frequently Asked Questions
Its proprietary Clover Assistant platform helps primary care doctors make better clinical decisions. The platform uses data from over a hundred sources to generate real-time patient insights. This clover health medicare review examines the company’s financial ratings, plan options, benefits, and customer satisfaction. Whether you are approaching 65 or considering a plan switch, this guide will help. Use it to evaluate whether Clover Health is right for your Medicare needs.
Clover Health Overview and Financial Strength
Any thorough clover health medicare review should start with company history and leadership. Vivek Garipalli and Kris Gale co-founded Clover Health in 2014. The company initially focused on Medicare Advantage in the New Jersey market. It expanded rapidly and merged with a SPAC to go public in 2021. Andrew Toy currently serves as CEO. The company employs approximately 724 people. Clover Health operates its insurance business through Clover Insurance Company, a state-regulated entity.
However, Clover Health does not carry a traditional AM Best financial strength rating. Most established Medicare insurers hold AM Best ratings as a mark of stability. As a result, beneficiaries should consider this gap when comparing Clover to legacy carriers. For the 2026 plan year, CMS awarded Clover’s PPO plans 3.
5 out of 5 stars. Its HMO plan received a higher 4.0-star rating. However, only 3% of Clover members are in plans rated 4 stars or above. The BBB gives Clover Health an A- rating, though the company is not BBB accredited. These mixed ratings reflect a company still building its reputation.
| Rating Source | Score / Grade |
|---|---|
| AM Best Financial Strength | Not Rated |
| CMS Star Rating (2026 PPO) | 3.5 out of 5 Stars |
| CMS Star Rating (2026 HMO) | 4.0 out of 5 Stars |
| NAIC Complaint Ratio | Not Published |
| JD Power (MA Satisfaction) | Not Individually Ranked |
| BBB Rating | A- (Not Accredited) |
Clover Health Medicare Review: Medicare Plan Options
This section of our clover health medicare review covers available plan types. Clover Health offers Medicare Advantage plans only. It does not sell Medigap supplement plans like Plan G or Plan N. Beneficiaries cannot enroll in both Medicare Advantage and Medigap at the same time. In most cases, members choose between Clover’s PPO and HMO options. The majority of plans are PPOs. PPO plans allow members to see out-of-network providers at a higher cost. HMO plans typically require referrals and in-network care only.
Most Clover Health plans include Part D prescription drug coverage. This means your medications are covered under the same plan. You can review the drug formulary through Clover’s member portal. For example, Clover Health Choice Value PPO is a popular plan with integrated Part D benefits. However, Clover does not offer standalone Part D prescription drug plans. As a result, you must enroll in a Medicare Advantage plan to access their drug coverage. Clover’s formulary covers a wide range of generic and brand-name medications.
This clover health medicare review notes that Clover’s D-SNP availability is limited. Beneficiaries who qualify for both Medicare and Medicaid should verify options locally. You can check plan availability at Medicare.gov Plan Finder by entering your zip code. Always confirm which plan types are offered in your county before starting enrollment.
Clover Health Medicare Rates and Enrollment
A complete clover health medicare review must address affordability. For 2026, approximately 68% of Clover’s non-SNP plans carry a $0 monthly premium. This makes Clover Health one of the more affordable Medicare Advantage options. However, the average out-of-pocket maximum runs roughly $7,600 per year. That figure is higher than many major competitors. Typically, lower premiums come with higher cost-sharing at the point of service. Beneficiaries should balance premium savings against potential out-of-pocket exposure.
You can enroll in Clover Health during the Annual Enrollment Period. This window runs from October 15 through December 7 each year. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. During this second window, existing MA members can switch to a different plan. Enrollment is available online through Clover Health’s website. You can also call their sales line directly. Working with a licensed insurance agent in your area is another option.
When comparing rates, consider total annual costs rather than premium alone. In most cases, a $0 premium plan may have higher copays and deductibles. Your specialist visit copay and prescription tier costs can add up quickly. Many Medicare beneficiaries also carry a life insurance policy to protect their family. You may want to compare life insurance rates at Life Insure Guide as part of your financial planning.
Clover Health Additional Benefits and Perks
Our clover health medicare review found that Clover offers strong supplemental benefits. All Medicare Advantage plans include dental, vision, and hearing coverage. Dental benefits cover two preventive exams per year. Comprehensive dental services like fillings, extractions, and root canals are also covered. Vision benefits typically include one routine eye exam annually. An annual eyewear allowance helps cover glasses or contact lenses.
Clover provides an OTC allowance ranging from $50 to $180 per quarter. That adds up to $200 to $720 per year, depending on your plan. Funds load onto a LiveHealthy Flex Plus card automatically. You can purchase approved items like bandages, vitamins, and first-aid supplies. Additionally, Clover covers telehealth appointments via phone or video. This gives members convenient access to care from home. Telehealth visits often carry lower copays than in-person appointments.
Fitness benefits are included with most Clover plans. However, Clover does not specifically advertise SilverSneakers membership. The company offers its own fitness program instead. Retirees should also review their homeowners coverage alongside Medicare choices. You can compare home insurance rates at Home Insure Guide for complete protection. The Clover Assistant AI platform is another unique perk for members. It helps your primary care doctor access real-time health data during appointments. This technology sets Clover apart from traditional Medicare Advantage insurers.
Clover Health Claims Process and Customer Service
In evaluating customer experience for this clover health medicare review, we examined multiple sources. Clover Health offers a member portal called My Clover. Through this portal, members can view ID cards, find doctors, and manage benefits. Claims for in-network visits are typically processed through the provider’s office. For out-of-network PPO claims, members may need to submit paperwork directly. The portal also allows members to track claim status online.
Clover Health’s customer service line is 1-833-547-2121. Representatives are available from 8 AM to 8 PM, seven days a week. TTY users can reach support at 1-855-649-4829. Members can also email [email protected] for assistance. However, third-party customer reviews paint a mixed picture. Trustpilot users rate Clover Health at just 1.7 out of 5 stars. BBB customer reviews average only 1.11 out of 5 stars. Common complaints include delayed welcome kits and difficulty reaching knowledgeable agents.
Clover Health is not individually ranked in JD Power’s Medicare Advantage satisfaction study. As a result, no independent satisfaction benchmark is available for comparison. Smaller regional insurers often fall outside JD Power’s ranking scope. On the positive side, Clover’s AI-driven approach aims to improve clinical outcomes over time. The company reports meaningful cost savings when primary care doctors use the Clover Assistant.
Pros and Cons of Clover Health Medicare Plans
Based on our clover health medicare review, here are the key strengths and drawbacks.
Pros:
- About 68% of plans have $0 monthly premiums for 2026
- AI-powered Clover Assistant helps doctors deliver data-driven, personalized care
- Dental, vision, hearing, and OTC allowance included with all plans
- PPO plan flexibility allows visits to out-of-network providers
Cons:
- Available in only five states — Georgia, New Jersey, Pennsylvania, South Carolina, and Texas
- Below-average CMS star ratings with PPO plans at 3.5 stars for 2026
- Higher-than-average out-of-pocket maximums at roughly $7,600 per year
- Poor customer reviews on BBB (1.11/5) and Trustpilot (1.7/5)
- No Medigap supplement plans or standalone Part D plans offered
Who Is Clover Health Best For?
After completing this clover health medicare review, the ideal candidate is clear. Clover Health is best for beneficiaries who want a $0 premium Medicare Advantage PPO plan. It suits those who value technology-driven healthcare and data-informed treatment. The Clover Assistant AI platform offers a genuine advantage over traditional insurers. If your primary care doctor uses the platform, you may receive more proactive care. This can lead to earlier diagnosis and better management of chronic conditions.
However, Clover Health may not be the right fit for everyone. Beneficiaries who prefer Original Medicare with a Medigap supplement should look elsewhere. Clover does not offer Plan G, Plan N, or any supplement plans. Those living outside the five-state service area cannot enroll. If top-tier customer service ratings are a priority, Clover’s below-average reviews are concerning.
In most cases, this clover health medicare review recommends Clover for tech-savvy Medicare beneficiaries. It works well for those who prioritize low premiums and extra benefits over star ratings. Compare Clover Health’s offerings with other Medicare Advantage plans at Medicare.gov to find the best fit for your needs.
Frequently Asked Questions
Is Clover Health a legitimate Medicare insurance company?
Yes, Clover Health is a legitimate, publicly traded Medicare Advantage insurer. It has operated since 2014 and holds active CMS contracts. However, it is younger than established carriers like UnitedHealthcare or Humana.
Does Clover Health offer Medigap or Medicare Supplement plans?
No, Clover Health does not offer Medigap supplement plans. It provides Medicare Advantage HMO and PPO plans only. As a result, beneficiaries wanting Plan G or Plan N must look at other insurers.
What states does Clover Health serve for Medicare Advantage in 2026?
Clover Health offers Medicare Advantage plans in five states for 2026. These states are Georgia, New Jersey, Pennsylvania, South Carolina, and Texas. Typically, coverage varies by county, so check Medicare.gov for your specific zip code.
Compare More Medicare Insurance Companies
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Official Sources & Resources
For verified information on Medicare plans, ratings, and enrollment:
- Medicare.gov (Official): medicare.gov
- CMS.gov (Centers for Medicare & Medicaid): cms.gov
- AM Best (Financial Strength Ratings): ambest.com
- NAIC (Complaint Ratios): naic.org
- State Health Insurance Assistance Program (SHIP): shiphelp.org
- Kaiser Family Foundation (KFF): kff.org
Content last reviewed April 2026. If you notice any outdated information, please contact us.