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Senior Whole Health SCO (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health SCO (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 SCO (HMO D-SNP) in 2026, please refer to our full plan details page.
Senior Whole Health SCO (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, Hdn, Ham, Mdsx, Nrflk, Plth, Sfk, Wor. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Senior Whole Health SCO (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 SCO (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 SCO (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 SCO (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $115.00 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 $9250.00 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 SCO (HMO D-SNP) prescription drug plan features an annual drug deductible of $115. Under this plan, Tier 1 drugs offer maximum savings with no copay when filled through preferred pharmacies or preferred mail-order services for one, two, or three-month supplies. Choosing preferred network options is an easy way for members to eliminate out-of-pocket costs for their medications. Alternatively, if you use a standard pharmacy or standard mail-order service, you will be responsible for a 25% coinsurance on all supply lengths. Evaluating these deductible and coinsurance details can help you decide if this plan provides the right balance of cost and coverage for your health needs.
Additional Benefits
The Senior Whole Health SCO (HMO D-SNP) plan offers comprehensive medical coverage with no copays for most services, though coinsurance rates typically apply. You will pay no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. However, outpatient care, emergency services, and primary or specialist visits generally require a coinsurance ranging from 10% to 30%. For supplemental care, this plan features no copays for dental, vision, and diagnostic hearing services, with preventive dental and select over-the-counter items also carrying no coinsurance. Other services, such as medical equipment, diagnostic tests, and Medicare-covered dental care, require a 20% coinsurance. Prior authorization is required for several key benefits, including inpatient stays, outpatient services, and medical equipment.
Inpatient Hospital See details
Senior Whole Health SCO (HMO D-SNP) features partially covered inpatient hospital services, which include acute and psychiatric care with no copay and no coinsurance, subject to prior authorization. However, additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Whole Health SCO (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Senior Whole Health SCO (HMO D-SNP) plan with no copay and a 30% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Senior Whole Health SCO (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to health-related locations are not covered.
Emergency Services See details
Senior Whole Health SCO (HMO D-SNP) covers emergency and urgent care services with a 30% coinsurance and no copay, which apply toward the plan-level deductible. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum benefit limit of $10,000.
Primary Care See details
Senior Whole Health SCO (HMO D-SNP) covers primary care, specialist, and outpatient therapy services with no copays and coinsurance ranging from 10% to 30%, while opioid treatment has no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Senior Whole Health SCO (HMO D-SNP) covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar and select additional benefits, though annual physical exams and in-home safety assessments are not covered. Other services, including kidney disease education, glaucoma screenings, and diabetes self-management training, feature no copay but require a 20% coinsurance.
Hearing Services See details
Senior Whole Health SCO (HMO D-SNP) covers diagnostic hearing exams with no copay and no coinsurance, but routine exams, fittings, and OTC hearing aids are not covered. For prescription hearing aids, some services are covered, but all specific types—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Senior Whole Health SCO (HMO D-SNP) provides partially covered vision services with no deductible, no copays, and a 20% coinsurance for contact lenses up to a $200 annual limit, while routine eye exams and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Senior Whole Health SCO (HMO D-SNP), with Medicare-covered dental services requiring no copay and a 20% coinsurance. Other covered preventive and comprehensive dental benefits feature no copay and no coinsurance, though other diagnostic services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Senior Whole Health SCO (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs—including chemotherapy, radiation, and insulin—are covered with a 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Senior Whole Health SCO (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Whole Health SCO (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and certain supplies may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Senior Whole Health SCO (HMO D-SNP) covers diagnostic and radiological services with no copayment, subject to a 20% coinsurance and prior authorization. Covered services include outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Senior Whole Health SCO (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Senior Whole Health SCO (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization required, though only some services are covered. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and carry a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Senior Whole Health SCO (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Senior Whole Health SCO (HMO D-SNP) offers partial coverage for other services, providing acupuncture for up to 40 treatments per year and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
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