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Molina Dual Options (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Dual Options (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Molina Dual Options (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
Molina Dual Options (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in South Carolina. The overall rating for this plan is not yet available for 2025.
It's important to know that Molina Dual Options (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Molina Dual Options (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Molina Dual Options (Medicare-Medicaid Plan).
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 Dual Options (Medicare-Medicaid Plan), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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:
Sign up for Molina Dual Options (Medicare-Medicaid Plan)
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Drug Coverage
The Molina Dual Options (Medicare-Medicaid Plan) has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs. After the deductible, you will pay the costs associated with your drugs until your total drug costs reach $2000, at which point you enter the next coverage phase.
Additional Benefits
The Molina Dual Options (Medicare-Medicaid Plan) offers a range of benefits with varying coverage. Many services, such as primary care, emergency services, vision, dental, and home health, are covered with no copay. The plan also includes coverage for hearing aids up to $1,500 annually, and a $4,000 yearly maximum for dental services. However, this plan has some limitations. While inpatient and outpatient services are covered, some specialized treatments and additional services may require prior authorization or are not covered. Additionally, some services such as outpatient substance abuse, certain hearing aids, and specific dental and vision procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare covered stays, and upgrades for both are not covered. Prior authorization is required for both acute and psychiatric care.
Outpatient Services See details
Outpatient Services, offered by Molina Dual Options (Medicare-Medicaid Plan), covers all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services; however, individual and group sessions for outpatient substance abuse are not covered. Prior authorization is required for outpatient hospital services, ambulatory surgical center (ASC) services, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Molina Dual Options (Medicare-Medicaid Plan) plan. All ambulance services are covered with prior authorization and no copay or coinsurance, but ground and air ambulance services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Molina Dual Options (Medicare-Medicaid Plan), with no copay or coinsurance for Emergency Services and Urgently Needed Services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered with no copay and no coinsurance. Chiropractic Services are partially covered, with Routine Chiropractic Care not covered. Mental Health Specialty Services and Psychiatric Services are partially covered, with Individual and Group Sessions not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by Molina Dual Options, but annual physical exams, personal emergency response systems (PERS), medical nutrition therapy (MNT), re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, home and bathroom safety devices and modifications, and counseling services are not covered. The plan covers nutritional/dietary benefits for up to 12 visits, and up to 8 additional sessions for smoking and tobacco cessation counseling.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 every two years). Prescription hearing aids (all types) are covered up to $1,500 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams, eyewear, and upgrades, with no copay. Contact lenses and eyeglasses (lenses and frames) are also covered with no copay.
Dental Services See details
Dental services are covered with a maximum plan benefit of $4,000 per year. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Molina Dual Options (Medicare-Medicaid Plan), with prior authorization required. The plan covers Medicare Part B Insulin Drugs, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
The Molina Dual Options (Medicare-Medicaid Plan) covers Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit with no copay or coinsurance, but requires prior authorization. Some services are covered, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered, and there is no copay.
Home Health Services See details
Home Health Services are covered, including Personal Care Services and Other 1 for Home Health Services like incontinence supplies. There is no copay or coinsurance for these services. Additional Hours of Care are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, and this plan offers additional days beyond those covered by Medicare. Non-Medicare-covered stays for SNF are also covered, with coinsurance and copay amounts available in the plan details.
Other Services See details
Other Services includes coverage for over-the-counter items with a maximum benefit of $100 every three months, and other services that are not covered include acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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