Clear One Advantage is a regional Medicare Advantage plan sold in select states
Clear One Advantage is a Medicare Advantage plan (also called Part C) operated by Alignment Healthcare. It is available only in certain counties across a few states — primarily California, Nevada, and Arizona — so whether you can enroll depends entirely on where you live. The plan combines hospital, medical, and prescription drug coverage into one monthly premium, which is typically lower than Original Medicare plus a separate Medigap policy.
Like all Medicare Advantage plans, Clear One Advantage requires you to use doctors and hospitals within its network, and it sets annual limits on what you pay out of pocket. The plan's actual costs, covered services, and network size vary by state and county, so two people in different regions paying the same premium may have very different coverage.
Key Takeaways
- Clear One Advantage is only available in parts of California, Nevada, and Arizona, so you must live in a covered county to enroll.
- The plan includes hospital, medical, and prescription drug coverage for a single monthly premium, with no separate Medigap policy needed.
- You must use doctors and hospitals in the Clear One Advantage network, and out-of-network care is usually not covered except in emergencies.
- Costs vary by county and year, so you should compare the plan's premium, deductible, and copays to Original Medicare and other plans available in your area.
- You can enroll during the annual Medicare open enrollment period (October 15 to December 7) or if you are newly may be able to access for Medicare.
How Clear One Advantage coverage works
Clear One Advantage combines three types of coverage — Part A (hospital), Part B (medical), and Part D (prescription drugs) — into a single plan. You pay one monthly premium instead of separate premiums for each part. The plan also typically includes dental, vision, and hearing benefits that Original Medicare does not cover, though the scope of these benefits changes year to year and varies by county.
To use the plan, you must see doctors and hospitals that are part of the Clear One Advantage network. If you see an out-of-network provider, you will usually pay the full cost yourself, unless it is an emergency. The plan sets an annual out-of-pocket maximum — the most you will pay in a year for covered services — but this maximum does not include your monthly premium.
Because Clear One Advantage is a managed care plan, your primary care doctor acts as a gatekeeper. You typically need a referral from your primary care doctor to see a specialist, and the plan may require prior approval before certain procedures or medications. This is different from Original Medicare, where you can see any doctor who accepts Medicare without a referral.
What you pay: premiums, deductibles, and copays
Clear One Advantage premiums vary by county and change each year. Some plans have a $0 monthly premium, while others charge $50 to $150 or more per month. Even if the premium is $0, you still pay the Part B premium to Medicare directly (currently $164.90 per month for most people in 2024, though this amount changes annually).
In addition to the premium, you will pay copays or coinsurance when you use services. A typical structure might be $10 to $50 for a doctor visit, $250 to $500 for an emergency room visit, and $0 to $300 for a hospital stay, but these amounts differ by county and plan year. The plan also has an annual deductible for some services, which you must pay before the plan begins to pay its share.
The plan sets an annual out-of-pocket maximum, which means once you have paid a certain amount in copays and coinsurance in a year, the plan covers 100% of covered services for the rest of that year. This maximum typically ranges from $4,500 to $7,000, depending on the plan and county, but you should verify the exact amount for your specific plan.
Network size and finding doctors in your area
Clear One Advantage networks are smaller than Original Medicare's network of all Medicare-accepting providers. Before you enroll, you should check whether your current doctors and preferred hospitals are in the plan's network. If your doctor is not in the network, you will need to either switch doctors or pay out of pocket for their services.
You can search the Clear One Advantage provider directory on the Alignment Healthcare website or by calling the plan's customer service number. The directory shows which doctors, specialists, and hospitals are in-network in your county. Keep in mind that networks change, so a doctor who is in-network when you enroll may leave the network later, and you should review the network annually during open enrollment.
If you live in a rural area or a county with limited providers, Clear One Advantage may have fewer options than Original Medicare. In that case, Original Medicare or a different Medicare Advantage plan with a larger network might be a better fit.
Prescription drug coverage under Clear One Advantage
Clear One Advantage includes Part D prescription drug coverage as part of the plan, so you do not need to enroll in a separate drug plan. The plan has a formulary — a list of covered medications — and you pay copays when you fill prescriptions. Copays typically range from $0 to $50 for generic drugs and $0 to $100 or more for brand-name drugs, depending on the drug's tier on the formulary.
Like all Part D plans, Clear One Advantage has a coverage gap (sometimes called the "donut hole") where your costs increase after you and the plan have spent a certain amount on drugs in a year. Once you reach the out-of-pocket maximum for the year, the plan covers 100% of covered drug costs for the rest of that year.
If a medication you take is not on the formulary, you can ask the plan for an exception, though the plan may deny the request. Your doctor can also request a formulary exception on your behalf. Before you enroll, check whether your current medications are covered and at what copay level.
Comparing Clear One Advantage to Original Medicare
Original Medicare (Part A and Part B) has no network restrictions — you can see any doctor or hospital that accepts Medicare. However, Original Medicare does not include prescription drug coverage, dental, vision, or hearing benefits. Most people with Original Medicare buy a Medigap policy to cover costs that Medicare does not pay, and they enroll in a separate Part D drug plan. The total cost of Original Medicare, Medigap, and Part D varies widely depending on which Medigap plan and drug plan you choose.
Clear One Advantage bundles all three types of coverage into one plan with a single out-of-pocket maximum. If you use a lot of health care services, the out-of-pocket maximum can protect you from very high costs. However, if you rarely see doctors or use medications, Original Medicare with a low-cost Medigap plan might cost less.
The choice between Clear One Advantage and Original Medicare depends on your health, your doctors' locations, your medications, and your budget. There is no single right answer — you should compare the actual costs and coverage for your situation each year during open enrollment.
When you can enroll in Clear One Advantage
You can enroll in Clear One Advantage during the annual Medicare open enrollment period, which runs from October 15 to December 7 each year. Coverage begins on January 1 of the following year. If you are newly may be able to access for Medicare (usually at age 65), you have a seven-month initial enrollment window that includes the month you turn 65 plus three months before and three months after.
If you miss the open enrollment period and do not have a may have access to life event, you cannot enroll in Clear One Advantage until the next open enrollment period. may have access to life events include losing employer coverage, moving to a new county, or certain changes in your health status. If you experience a may have access to event, you have 60 days to enroll.
You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE, or by contacting Clear One Advantage (Alignment Healthcare) directly. You will need your Medicare number and information about your current coverage.
Frequently Asked Questions
Is Clear One Advantage available where I live?
Clear One Advantage is available only in select counties in California, Nevada, and Arizona. You can check whether it is available in your county by entering your zip code on Medicare.gov or by calling 1-800-MEDICARE. Availability changes year to year, so a plan that was available last year may not be available this year.
Can I keep my current doctor with Clear One Advantage?
Only if your doctor is in the Clear One Advantage network in your county. Before you enroll, search the plan's provider directory to confirm your doctor is listed. If your doctor is not in-network, you will need to either switch doctors or pay out of pocket for their care.
What happens if I need emergency care outside my county or state?
Clear One Advantage covers emergency care anywhere in the United States. You pay the plan's emergency room copay (typically $250 to $500) and the plan covers the rest of the emergency care. Non-emergency care outside the network is usually not covered, so you should plan ahead if you travel frequently.
Can I switch back to Original Medicare if I do not like Clear One Advantage?
Yes. You can switch to Original Medicare during the annual open enrollment period (October 15 to December 7) or during the Medicare Advantage open enrollment period (January 1 to March 31). If you switch to Original Medicare, you should also enroll in a Medigap policy and a Part D drug plan during the same period.
How do I find out the exact costs for Clear One Advantage in my area?
Visit Medicare.gov and use the plan finder tool, or call 1-800-MEDICARE. You can also contact Alignment Healthcare directly. The plan's official summary of benefits and coverage document shows the premium, deductibles, copays, and out-of-pocket maximum for your specific county and plan year.