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Senior Whole Health (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Whole Health (HMO D-SNP) in 2025, please refer to our full plan details page.
Senior Whole Health (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Senior Whole Health (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Senior Whole Health (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Whole Health (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Senior Whole Health (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.80. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $16.30. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Senior Whole Health (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for low-income subsidy (LIS), the monthly premium for Part D is $42.80. In the initial coverage phase, after the deductible is met, you will pay the cost for your prescriptions until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Senior Whole Health (HMO D-SNP) plan offers a variety of benefits with a focus on cost-sharing through coinsurance. Many services have a 20% coinsurance, including outpatient services, primary care, vision, dental, and medical equipment. The plan also covers home health services and diagnostic and radiological services with no copay. The plan provides coverage for transportation services, emergency services, and home infusion services. Additionally, it includes coverage for acupuncture, with a limit of 40 treatments per year, and over-the-counter (OTC) items up to $75.00 per month. However, some services like cardiac rehabilitation, and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Senior Whole Health (HMO D-SNP) plan, but additional days, non-Medicare covered stays, and upgrades are not covered. Cost sharing details, including coinsurance, are available.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, while individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization, and requires a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Senior Whole Health (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services to a plan-approved health-related location are covered for up to 80 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Senior Whole Health (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a maximum plan benefit coverage amount of $10,000.
Primary Care See details
The Senior Whole Health (HMO D-SNP) plan covers primary care, physician specialist services, physical therapy, speech-language pathology, and individual and group mental health and psychiatric sessions with a 20% coinsurance. Chiropractic services are partially covered, with routine care not covered. Occupational therapy services are covered with a 20% coinsurance, and other healthcare professional and opioid treatment program services are covered with a 20% coinsurance.
Preventive Services See details
Preventive Services are covered, though the annual physical exam, in-home safety assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered. Additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with a 20% coinsurance.
Hearing Services See details
Hearing Services are covered by the Senior Whole Health (HMO D-SNP) plan, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. There is a coinsurance of at most 20% for hearing exams.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a combined maximum plan benefit coverage of $200 per year. Routine eye exams are covered once per year.
Dental Services See details
Dental services are partially covered, with Medicare Dental Services covered at 20% coinsurance. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Senior Whole Health (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Senior Whole Health (HMO D-SNP) plan, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Senior Whole Health (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Senior Whole Health (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C and does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays.
Other Services See details
The Senior Whole Health (HMO D-SNP) plan covers acupuncture with a limit of 40 treatments per year, as well as over-the-counter (OTC) items up to $75.00 per month. Other services such as meal benefits, case management, and home-based services are not covered.
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