Clever Care Health Plan Inc.

What Clever Care Health Plan Inc. does

Clever Care Health Plan, Inc. is a privately held Medicare Advantage HMO and HMO C-SNP carrier headquartered in Huntington Beach, California, serving approximately 51,000 members across Los Angeles, Orange, San Diego, Riverside, and San Bernardino counties. The company's core offering integrates Western medical coverage with Eastern modalities such as acupuncture, cupping, massage, reflexology, and an 800+ SKU herbal-supplement catalog accessible through the NationsBenefits flex card and partner retailers including TS Emporium and Korea Ginsong Corporation. Its portfolio comprises four plan types: Clever Care Value (HMO), Clever Care Longevity (HMO flagship), Clever Care Breathe+ (HMO C-SNP for respiratory conditions), and Clever Care Total+ (HMO C-SNP for cardiovascular disorders, chronic heart failure, and diabetes), with premiums ranging from $0 to plans offering a $120 Part B premium reduction and maximum-out-of-pocket between $500 and $9,250 depending on plan and dual-eligible status. Distribution is multi-modal: a self-service multilingual digital enrollment portal (English, Chinese, Korean, Vietnamese, Spanish), a 1,000+ broker partner network, licensed agent phone sales, and a physical footprint of community centers in Koreatown, Little Saigon, San Gabriel, Monterey Park, and Rowland Heights staffed with bilingual advisors. The technology stack is anchored by HL7 FHIR R4 Patient Access and Provider Directory APIs (OAuth 2.0-secured) and the NationsBenefits benefits-administration platform, with provider networks spanning 15,000+ facilities, 50+ hospitals, 600+ acupuncturists, and 2,000+ bilingual physicians.

Clever Care generates revenue through CMS capitation payments for its MA and C-SNP contracts, effectively a subscription-style recurring revenue model tied to member enrollment and risk adjustment. Customer acquisition is community-led and demographically targeted: 84% of members preferred non-English support in 2023, and 70%+ of staff are ethnic minorities. The company has raised $138 million in cumulative venture funding (Series A $6M in 2019, Series B $71M in 2021, Series C $42M in 2023 led by GV with Point32Health), and underwent a leadership transition in 2024-2025 in which co-founder Myong Lee stepped aside as CEO for Karen Walker Johnson, a 35-year healthcare veteran from Centene, Health Net, WellCare, UnitedHealthcare, Cigna, and Cleveland Clinic. The wholly-owned operating subsidiary, Clever Care of Golden State, Inc., holds the CMS contracts.

Name

Clever Care Health Plan Inc.

Legal name

Clever Care Health Plan, Inc.

Website

https://clevercarehealthplan.com

Company type

Private

Founded year

2018

Operating status

Operating

Headcount range

101–250 employees

Short description

Clever Care Health Plan is a privately held Medicare Advantage HMO and C-SNP carrier serving about 51,000 AAPI seniors in five Southern California counties, integrating Western medical coverage with Eastern wellness benefits and delivering care through community centers, a 1,000+ broker network, and multilingual digital channels.

Ownership category

akta.pro rank

Product category

Medicare Advantage Health Insurance

NAICS

Direct Life, Health, and Medical Insurance Carriers (52411), Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Medicare Advantage (MA) Plans (FSAIAGAA)

akta.pro secondary industries

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), D-SNP Supplemental Benefits & Flex Card/OTC Administration (HLAEAFAN)

Keywords

• Medicare Advantage plans
• Integrated Eastern medicine
• Culturally sensitive healthcare
• HMO C-SNP plans
• Multilingual member services

Headquarters

HQ city

Huntington Beach

HQ country

United States

HQ region

North America

Offices7 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Marketing or Sales, Personnel, Technology or R&D, Supply Chain, Others

Revenue model

1. Medicare Advantage Premiums: Clever Care generates revenue through Medicare Advantage plan premiums collected from members. The company offers HMO and HMO C-SNP plans with monthly premiums, deductibles, and maximum-out-of-pocket costs. Revenue is derived from CMS contracts based on member enrollment.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

Clever Care Health Plan is a Medicare Advantage HMO and HMO C-SNP carrier that sells integrated health plans combining Western medical coverage with Eastern wellness therapies (acupuncture, cupping, herbal supplements, massage, reflexology). It serves Medicare-eligible individuals in five Southern California counties, with multilingual member support in English, Chinese, Korean, Vietnamese, and Spanish, and physical community centers in culturally diverse neighborhoods.

Product overview

Clever Care Health Plan is a Medicare Advantage HMO and HMO C-SNP plan provider that offers a platform of culturally-sensitive health plans serving Southern California. The core product portfolio includes four main plan types: Clever Care Value (essential HMO), Clever Care Longevity (flagship comprehensive HMO), Clever Care Breathe+ (C-SNP for respiratory conditions), and Clever Care Total+ (C-SNP for cardiovascular/diabetic conditions). All plans integrate Eastern and Western medicine benefits including acupuncture, cupping, herbal supplements, and flexible wellness allowances. The company provides technology products including FHIR-compliant Patient Access APIs for interoperability, NationsBenefits flex cards for benefit management, and multilingual community centers for in-person support. Plans serve Los Angeles, Orange, San Diego, Riverside, and San Bernardino counties.

Differentiator

Problem solved

Functional benefit

Products and services

• Clever Care Value (HMO) An essential Medicare Advantage HMO plan offering a $120 Part B premium reduction and a $2,000 maximum-out-of-pocket, including dental, vision, hearing, transportation, and Eastern wellness benefits for Medicare-eligible individuals in Southern California.
• Clever Care Longevity (HMO) The flagship comprehensive Medicare Advantage HMO plan with a $500 maximum-out-of-pocket, a $315 quarterly flex allowance, $1,100 dental every six months with rollover, and unlimited Eastern wellness therapies, designed for Medicare beneficiaries seeking the richest benefit package.
• Clever Care Breathe+ (HMO C-SNP) A holistic Medicare Advantage HMO Chronic Condition Special Needs Plan for individuals diagnosed with asthma, chronic bronchitis, emphysema, or COPD, available with or without full Medi-Cal eligibility.
• Clever Care Total+ (HMO C-SNP) A holistic Medicare Advantage HMO Chronic Condition Special Needs Plan for individuals diagnosed with cardiovascular disorders, chronic heart failure, or diabetes, available with or without full Medi-Cal eligibility.
• FHIR Patient Access and Provider Directory APIs Standards-based HL7 FHIR R4 APIs enabling third-party health applications to access member health information including claims, encounters, clinical data, conditions, medications, allergies, lab results, and provider directory information, with OAuth 2.0 secured endpoints.

Quantifiable outcome

• 112% year-over-year membership growth, now serving 22,000+ members
• +3 more outcomes

Named customers1 record

Segments3 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature2 records

Partnerships

13 partnerships are on record, tiered core and minor.

• CareMore HealthcoreStrategic or Co-development Partner · 15 March 2023Partnership adding 350+ primary care providers across Los Angeles, Orange, and San Bernardino counties, enhancing access to culturally-sensitive primary care for Clever Care members.
• Allied Pacific IPAcoreStrategic or Co-development Partner · 26 November 2022One of the largest provider networks in Southern California, serving over 350,000 patients in the greater San Gabriel Valley area with 1,337 primary care and specialty physicians.
• Alpha Care Medical GroupcoreStrategic or Co-development Partner · 26 November 2022Independent Physician Association serving Inland Empire communities with over 1,479 primary care physicians and specialists serving Riverside and San Bernardino Counties.
• Accountable Health Care IPAcoreStrategic or Co-development Partner · 26 November 2022IPA serving residents of greater Long Beach area and Downtown Los Angeles with over 1,000 primary care and specialty physicians committed to high-quality, patient-focused care.
• Blue Zones HealthcoreStrategic or Co-development PartnerPartnership bringing 2,500+ whole person care providers to Medicare Advantage members in Southern California, supporting the company's whole-health approach combining Eastern and Western medicine.
• TS EmporiumcoreStrategic or Co-development PartnerExpanded partnership offering 75 new herbal supplements to existing catalog of 800 products. SSBCI-eligible members can purchase groceries at TS Emporium locations. Largest provider of Traditional Chinese Medicine and Asian delicacies in the Americas.
• Korea Ginseng CorporationminorStrategic or Co-development PartnerSupplier partnership offering CheongKwanJang brand ginseng products. Korea Ginseng Corporation has over 120 years of history and is the number one ginseng brand worldwide.
• Providence Health NetworkcoreStrategic or Co-development PartnerHospital network partnership providing Clever Care members access to extensive network of hospitals and specialists in Southern California.
• Prospect Medical Group / Prospect IPAcoreStrategic or Co-development PartnerPartnership with Prospect IPA to provide vast healthcare choices for comprehensive care, expanding provider access for members through Prospect Medical Group network.
• Liberty Dental PlanminorStrategic or Co-development PartnerDental network provider accessible through Clever Care's plan finder tools, providing members with access to dental services.
• VSP (Vision Service Plan)minorStrategic or Co-development PartnerVision provider network accessible through plan finder, providing members with access to routine vision care and eyewear.
• NationsHearingminorStrategic or Co-development PartnerHearing provider network accessible through plan finder, providing members with hearing exams and hearing aid coverage.
• NationsBenefitscoreStrategic or Co-development PartnerBenefits administrator for over-the-counter products, herbal supplements, and flexible allowance programs. Manages 3,500+ participating retail locations including CVS, Walgreens, Costco, and ethnic supermarkets.

Scale indicators12 records

Recent moves12 records

Expansion highlights6 records

Broad incumbents

• Kaiser Permanente: Integrated California-based MA carrier combining provider network and health plan; broad incumbent serving large senior populations in Southern California with full Medicare Advantage options.
• Humana: Top-three national MA carrier with growing California footprint and extensive broker channels; broad incumbent competing for senior and dual-eligible members in the same counties.
• Blue Shield of California: Major California-based health plan offering Medicare Advantage HMO and PPO products across the same Southern California counties; comparable as a broad incumbent in the same geography with overlapping senior and culturally-tailored benefits.
• Anthem Blue Cross (California): One of the largest Medicare Advantage carriers in California with extensive broker networks and supplemental benefits; broad incumbent competing for the same senior segment in Clever Care's core counties.
• UnitedHealthcare (AARP Medicare Advantage): Largest national MA carrier with significant California membership; broad incumbent offering AAPI-targeted marketing and multilingual support that directly competes with Clever Care's value proposition.
• Aetna (CVS Health): Major national MA carrier with broad California presence and dual-eligible D-SNP offerings; broad incumbent that competes for similar senior and dual-eligible members.

Direct peers

• Alignment Health Plan: California-focused Medicare Advantage HMO plan with tech-enabled senior care model; directly comparable as a subscale, growth-oriented MA carrier competing in the same California counties with senior-focused benefits and a similar capital-backed growth profile.
• Scan Health Plan: California-based, not-for-profit Medicare Advantage HMO with deep Southern California roots and senior-focused benefits; directly comparable as a regional California MA carrier with culturally responsive member programs.
• Clover Health: Tech-enabled Medicare Advantage carrier focused on senior care and primary-care-clinic integration; directly comparable as a venture-backed, growth-stage MA insurer pursuing a differentiated model with similar capital-market profile.

Emerging players

• Astana Health (formerly Apollo Medical Holdings / Network Medical Management): California-based value-based care and IPA organization with significant MA risk-bearing exposure; comparable as an emerging player providing provider infrastructure for MA plans serving AAPI populations in California.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 records

Subsidiaries1 record

Funding overview

Funding rounds4 records

Investors13 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Clever Care Health Plan Inc.