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Molina Medicare Complete Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Medicare Complete Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Molina Medicare Complete Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Molina Medicare Complete Care (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Counties: CC, Clark, Doug, Lyon, Nye, Storey, Wash. The overall rating for this plan is not yet available for 2026.
It's important to know that Molina Medicare Complete Care (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:
Molina Medicare Complete Care (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 Molina Medicare Complete Care (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 Molina Medicare Complete Care (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 $575.00 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 $9100.00 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 Molina Medicare Complete Care (HMO D-SNP) plan features an annual drug deductible of $575. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. Tier 2 generic drugs are also highly affordable, costing a $2.00 copay for a one-month supply and a $4.00 copay for two- or three-month supplies. For higher-tier medications, the plan transitions to coinsurance costs. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance for standard pharmacy and standard mail-order fills. Specialty drugs in Tier 5 require a 25% coinsurance for a one-month supply.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers comprehensive coverage with no copays for many essential services, including inpatient hospital stays, primary care visits, and home health care. While there are no copays for most medical services, patients will typically pay a coinsurance, such as 20% for outpatient services, dialysis, and medical equipment, or 30% for specialist visits and emergency care. There is also no deductible for outpatient blood services, making overall out-of-pocket costs highly predictable. This plan also features valuable everyday benefits with no copays, including routine vision exams with a $200 annual eyewear allowance and preventive dental care up to a $3,600 yearly limit. Additionally, members benefit from no copays and no coinsurance for unlimited one-way transportation to plan-approved locations, over-the-counter items, and routine hearing aids. While some specialized treatments require prior authorization or a 20% coinsurance, the plan provides robust support for overall wellness and daily health needs.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services with the first three pints waived.
Partial Hospitalization See details
Partial hospitalization is covered under Molina Medicare Complete Care (HMO D-SNP) with no copay and a 30% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Molina Medicare Complete Care (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services, which require prior authorization. Unlimited one-way transportation to plan-approved health-related locations is provided with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Molina Medicare Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, with the emergency coinsurance waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum plan benefit of $10,000.
Primary Care See details
Primary care benefits under the Molina Medicare Complete Care (HMO D-SNP) plan feature no copays for covered services, with most care—including primary care, specialist, and mental health visits—requiring a 30% coinsurance. While chiropractic services are not covered, opioid treatment services are available with no copay and no coinsurance.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams and select additional benefits like fitness and nutritional training, though many sub-services such as weight management and in-home support are not covered. Other covered services, including kidney disease education, glaucoma screenings, and diabetes self-management training, feature no copay and a 20% coinsurance.
Hearing Services See details
Molina Medicare Complete Care (HMO D-SNP) covers hearing services, including OTC hearing aids with no copay and no coinsurance, and routine hearing exams with no copay but a 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices per year, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, as other eye exam services are not covered. The plan covers one routine eye exam per year and provides up to a $200 annual maximum for eyewear, including contacts, lenses, frames, and upgrades.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) covers dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive dental services up to a $3,600 annual limit. The benefit is partially covered, as implants, fixed prosthodontics, maxillofacial prosthetics, orthodontics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and some items must be sourced from preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers diagnostic and radiological services with prior authorization, featuring no copay and a 20% coinsurance for lab services, diagnostic procedures, and outpatient X-rays. However, diagnostic and therapeutic radiological services are not covered under this plan.
Home Health Services See details
Home health services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers some cardiac rehabilitation services with no copay, subject to prior authorization. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While the plan allows for admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers other services, offering over-the-counter items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization.
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