Health Plan RadarIn this article we rank South Carolina Medicare Advantage plans based on our evaluation of government 5-star quality scores.
Read more →Clover Health LiveHealthy (PPO)
by Clover Health
2026 Medicare Advantage plan available in South Carolina
Plan ID H5141-036-0
Additional coverage:
RxHearingVisionDental
Medicare Advantage PPO $0 premium 3.5 Overall
Monthly plan premium $0 / mo
Annual deductible $0 / yr
Max out-of-pocket · in-network $6,500 / yr
Drug deductible $0 / yr
3.5 Overall Government Star Rating 2026 · out of 5 stars
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Plan Overview
Clover Health LiveHealthy (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in South Carolina and offered by the health insurance company Clover Health. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.
Plan Name Clover Health LiveHealthy (PPO)
Insurance Carrier Clover Health
Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type PPO
Cost Summary
Clover Health LiveHealthy (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $6,500. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $0 / mo
Health portion of premium $0
Drug portion of premium $0
Annual Deductible $0 / yr
Max Out-of-Pocket · in-network $6,500 / yr
Primary doctor visit $0 copay
Specialist visit $10 copay
ER visit $115 copay
Ambulance $350 copay
Additional Benefits and Coverage
Clover Health LiveHealthy (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Clover Health LiveHealthy (PPO) includes coverage for hearing, vision, dental.
Part D Prescription Drug Coverage Yes
Dental Yes
Vision Yes
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Limited coverage
Over-the-counter drug benefits Limited coverage
In-home support services Not covered
Home & bathroom safety devices Not covered
Meals for short duration Not covered
Annual physical exams Limited coverage
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Specialist visit In-network: $10 copay
Out-of-network: $30 copay
Out-of-network: $30 copay
Tests, labs & imaging
Diagnostic tests & procedures In-network: $0-$175 copay
Out-of-network: $0-$400 copay
Out-of-network: $0-$400 copay
Lab services In-network: $0-$20 copay
Out-of-network: $20 copay
Out-of-network: $20 copay
Diagnostic radiology services (like MRI) In-network: $50-$175 copay
Out-of-network: $80-$400 copay
Out-of-network: $80-$400 copay
Outpatient x-rays In-network: $30 copay
Out-of-network: $60 copay
Out-of-network: $60 copay
Emergency care $115 copay
Urgent care $25 copay
Hospital Services
Inpatient hospital coverage In-network:
Tier 1
$375 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$495 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Tier 1
$375 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$495 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Outpatient hospital coverage In-network: $295 copay
Out-of-network: $450 copay
Out-of-network: $450 copay
Skilled nursing facility
Skilled nursing facility In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
40% per stay
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
40% per stay
Preventive services
Preventive services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance In-network: $350 copay
Out-of-network: $350 copay
Out-of-network: $350 copay
Therapy services
Occupational therapy visit In-network: $15 copay
Out-of-network: $30 copay
Out-of-network: $30 copay
Physical therapy & speech & language therapy visit In-network: $15 copay
Out-of-network: $30 copay
Out-of-network: $30 copay
Mental health services
Outpatient group therapy with a psychiatrist In-network: $15 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Outpatient individual therapy with a psychiatrist In-network: $15 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Outpatient group therapy visit In-network: $15 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Outpatient individual therapy visit In-network: $15 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Opioid treatment services
Opioid treatment services Covered
Other services
Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Preferred Generic $0.00 copay $0 copay
Generic $8.00 copay $0 copay
Preferred Brand $47.00 copay $0 copay
Non-Preferred Drug $100.00 copay $0 copay
Specialty Tier 33% coinsurance $0 copay
Part B drugs
Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Medicare star rating
Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Clover Health LiveHealthy (PPO) earned an overall rating of 3.5 stars — worse than South Carolina's state average of 3.8 stars.
Rating category This plan State average
Overall star rating ★ 3.5 3.8
Health plan quality
Summary rating of health plan quality ★ 3.5 3.9
Staying healthy: screenings, tests & vaccines ★ 4.0 3.5
Managing chronic (long-term) conditions ★ 4.0 3.3
Member experience with health plan ★ 3.0 4.0
Member complaints & changes in performance ★ 4.0 4.0
Health plan customer service ★ 3.0 4.1
Drug plan quality
Summary rating of drug plan quality ★ 3.0 3.7
Drug plan customer service ★ 3.0 4.9
Member complaints & changes in performance ★ 4.0 3.7
Member experience with the drug plan ★ 3.0 3.7
Drug safety & accuracy of drug pricing ★ 3.0 3.6
Extra Benefits
Hearing
Hearing exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription In-network: $499-$999 copay
Out-of-network: $5000 copay
Out-of-network: $5000 copay
Hearing aids - over the counter Not covered
Preventive dental
Oral exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Cleaning In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Dental x-rays In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Endodontics In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Periodontics In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Prosthodontics, removable In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, fixed In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Maxillofacial prosthetics In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Implant services In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Oral and maxillofacial surgery In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Orthodontics Not covered
Adjunctive general services In-network: $20 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Vision
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Contact lenses In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only) Not covered
Eyeglass lenses (only) Not covered
Upgrades Not covered
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