Clever Care Breathe+ (HMO C-SNP)
Clever Care Health Plan · HMO C-SNP · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $9,850
- Tied for highest here
- Drug deductible
- $700
- Tied for highest here
- Medicare star rating
- No rating yet
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 31 other plans in San Diego County that the same person could join.
What stands out
- No monthly premium
- $95 for the emergency room, lower than most plans here
- Dental, vision and hearing extras included
Watch out for
- Up to $9,850 a year for covered care, tied for highest here
- $25 for urgent care, higher than most plans here
- $700 drug deductible, tied for highest here
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.Not counted, because the plan charges a percentage: Lab tests.
- A busier year$25$0 in premiums + $25 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: Lab tests, X-rays.
- A hard year$95$0 in premiums + $95 for careLower than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Lab tests, MRI, CT and other scans, Ground ambulance, Hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care$25Higher than most plans here
- Emergency room$95Lower than most plans hereNot charged if you stay in the hospital within 72 hours
- Lab tests20%Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans20%Referral neededPlan approval may be needed
- Ground ambulance20%Plan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 31 other plans in San Diego County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $0 |
| 3Preferred BrandAfter the deductible | 23% of the price |
| 4Non-Preferred DrugAfter the deductible | 25% of the price |
| 5Specialty TierAfter the deductible | 25% of the price |
| 6Select Care Drugs | $0 |
For a 1-month supply. The $700 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2027, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.Cleanings and exams: plan pays up to $1,300 every six months. Plan pays up to $1,300 every six months for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $350 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $600 a year per ear.
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included48 one-way rides to medical visits a year.
What changed from 2026
- Most you pay in a year2026$9,2502027$9,850
- Drug deductible2026$6152027$700
- Dental2026Cleanings and exams: $0. Fillings, crowns and dentures: you pay $0. Cleanings and exams: plan pays up to $1,200 every six months. Plan pays up to $1,200 every six months for all dental2027Cleanings and exams: $0. Fillings, crowns and dentures: you pay $0. Cleanings and exams: plan pays up to $1,300 every six months. Plan pays up to $1,300 every six months for all dental
- Vision2026Yearly eye exam: $0. Glasses or contacts covered. Eyewear has a limit; ask the plan2027Yearly eye exam: $0. Glasses or contacts covered. Eyewear: plan pays up to $350 a year
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Clever Care Breathe+ (HMO C-SNP), plan number H7607-017, for 2027?”