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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 2025, 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 Select Counties in TX. The overall rating for this plan is not yet available for 2025.
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 $16.20. 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 $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 Molina Medicare Complete Care (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), your Part D premium will be $16.20. Once your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for your Part D covered drugs.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, including outpatient services, primary care, preventive services, hearing, vision, dental, and home infusion bundled services, require you to pay a coinsurance of up to 20%. There are also benefits with no copay, such as home health services, and diagnostic and radiological services. This plan covers inpatient and outpatient services, emergency services, and ambulance services. It also includes coverage for hearing aids, vision services, and dental services. Additionally, this plan offers extra benefits like an over-the-counter (OTC) allowance of $30 per month, acupuncture treatments, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Molina Medicare Complete Care (HMO D-SNP) plan; however, additional days, non-Medicare covered stays, and upgrades for inpatient hospital acute and psychiatric care are not covered. Coinsurance applies, and prior authorization is required for both acute and psychiatric care.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Molina Medicare Complete Care (HMO D-SNP) plan, with a 20% coinsurance. Observation Services and Outpatient Blood Services are also covered with a 20% coinsurance. Additionally, Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services have a coinsurance between 20%.
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 this plan, with prior authorization required. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services - Plan Approved Health-related Location are not covered, and Transportation Services - Any Health-related Location covers 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services have a maximum benefit coverage of $10,000.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under Primary Care. Individual and group mental health and psychiatric sessions have a 20% coinsurance. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar services, annual physical exams, and additional preventive services with prior authorization. Kidney disease education services, Glaucoma screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams with at most 20% coinsurance, and routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are partially covered, with coverage for all types limited to two visits every two years, but not for inner ear, outer ear, or over-the-ear hearing aids; OTC hearing aids are covered, with a limit of two hearing aids every two years.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear, with a 20% coinsurance. Eyewear has a combined maximum plan benefit coverage of $200 every year.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Oral exams are covered up to 2 visits per year, and dental x-rays are covered up to 1 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered with coinsurance for Medicare-covered Diabetic Supplies and Therapeutic Shoes/Inserts, and requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered with no copay. You may have to pay coinsurance of at most 20% for these services.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan does not offer additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a limit of 20 treatments per year and requires prior authorization, while the OTC benefit provides $30 per month for approved items, including nicotine replacement therapy and Naloxone. The meal benefit is provided immediately following surgery or inpatient hospitalization, for a chronic illness, or for a medical condition. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, and others are not covered.
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