Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Clover Health Choice Giveback, 2027

H5141Contract054Plan

PPO · 20 counties in New Jersey

Run by Clover Insurance Company (contract H5141), sold as Clover Health, owned by Clover Health Holdings, Inc.

Renews for 2027

2026 star rating, contract H5141: 4.5 of 5

Clover Health Choice Giveback (H5141-054) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $9,850 ($8,499 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit	$8,499	$9,850	up $1,351
Drug deductible	$200	$440	up $240
Part B premium reduction, monthly	$110	$140	up $30
Specialist visit	$30 copay	$50 copay	up $20
Hospital stay, in network	$350 a day for days 1–6, then $0 a day for days 7–90	$545 a day for days 1–4, then $0 a day for days 5–90	up $430for a 5-day stay
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Ground ambulance, in network	$350 copay	$335 copay	down $15
Over-the-counter items, yearly	$200 a year	$100 a year	down $100
Drug tier 2, generic	$8	$0	down $8
Drug tier 4, non-preferred drug	$100	35% of the cost	changed
Drug tier 5, specialty tier	30% of the cost	28% of the cost	down 2 points
10 lines do not change
Monthly premium	$0	$0	no change
Primary care visit	$0 copay	$0 copay	no change
Emergency room	$115 copay	$115 copay	no change
Medical deductible, in network	none	none	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Eyewear, yearly limit	$200 a year	$200 a year	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Counties served	20	20	no change
Drug tier 1, preferred generic	$0	$0	no change
Drug tier 3, preferred brand	$47	$47	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	$0	$0
Tier 2	Generic	$8	$0
Tier 3	Preferred Brand	$47	$47
Tier 4	Non-Preferred Drug	$100	35% of the cost
Tier 5	Specialty Tier	30% of the cost	28% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 54 plans open to everyone are sold for 2027, this one included. Against the others, 26 plans have a lower out-of-pocket limit, 27 the same. On the premium, 30 the same, 23 a higher one.

Out-of-pocket limits of the 54 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0000 plans

$4,000 to under $6,0002 plans

$6,000 to under $8,00010 plans

$8,000 to $10,000 (this plan)42 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 20 counties: $0 a month and $9,850.

New Jersey

Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H5141-054
Legal name of the contract: Clover Insurance Company
Sold as: Clover Health
Parent company: Clover Health Holdings, Inc.
Plan type: PPO
2026 star rating of the contract: 4.5 of 5 overall; health plan 3.5 of 5, drug plan 3 of 5
Members, September 2026: 24,009
Plan website, as filed with CMS: www.cloverhealth.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Middlesex, NJWhere most of its members live; premiums and limits side by side
Every Clover Health plan for 2027Its contracts, counties and plans that end
The other 13 plans of contract H5141Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.