Clover Health Investor Day Presentation Deck
Step 4: Providing Better Care At A Lower Cost
Illustrative Out of Pocket Costs(¹)
Clover
PCP
Copay
Specialist
Copay
Drug
Deductible
OTC
Allowance
Avg.
Annual Cost
Avg.
Lifetime Cost
$0
$5-$20
$150 - $200 (5)
$346
$1,871
$13,094
Competitor
$5
$25 - $45
$200 - $240
$25
$2,257
$15,801
Savings
$5
(100%)
$20-$40
(80%-89%)
$0 - $90
(0% -38%)
$387
$2,707
17% cost savings
Note: Assumes lifetime of 7 years
(1) Company analysis. Competitor column represents MA plans offered by the competitor with largest market share in the five counties where Clover has the most members.
(2) Kaiser Family Foundation.
(3) Calculated assuming a 20% coinsurance rate applied to the estimated 2021 primary care visit cost of $103 and level 5 E/M visit cost of $148 respectively (from CMS).
(4) 2016 average out-of-pocket spending on medical and long-term care services (from Kaiser Family Foundation).
(5) Members with the federal low-income subsidy (LIS) pay $0; $200 represents an average that is comparable to our competitors after considering the LIS.
Medicare
$21(3)
$30(3)
$651(2)
$0
$3,166(4)
$22,162
41% cost savings
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