A non-government entity
Molina Medicare Choice Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Medicare Choice Care (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Molina Medicare Choice Care (HMO) in 2026, please refer to our full plan details page.
Molina Medicare Choice Care (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Select counties in IL. The overall rating for this plan is not yet available for 2026.
It's important to know that Molina Medicare Choice Care (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Molina Medicare Choice Care (HMO).
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 Choice Care (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $51.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 Molina Medicare Choice Care (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 6 select care drugs, you will pay no copay for one-month, two-month, or three-month supplies at standard pharmacies and through standard mail order. Tier 1 preferred generic drugs cost a $3 copay for a one-month supply, while Tier 2 generic drugs require a $12 copay. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, though you can save on three-month supplies by choosing standard mail order for a $94 copay instead of $141 at a standard retail pharmacy. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs costing 40% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance for a one-month supply.
Additional Benefits
The Molina Medicare Choice Care (HMO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits and preventive services like annual physicals. For inpatient hospital stays, members pay a $295 daily copay for days 1 through 6, with no copay required for days 7 through 90. Emergency room visits require a $115 copay, which is waived if you are admitted to the hospital within 24 hours. Specialist visits carry a $40 copay, while physical, occupational, and speech therapies require a $35 copay. Skilled nursing facility care is highly accessible with no copay for the first 20 days, though you will pay a 20% coinsurance for durable medical equipment and dialysis services. It is important to note that routine dental, routine vision, hearing aids, and transportation services are not covered under this plan.
Inpatient Hospital See details
Molina Medicare Choice Care (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required and additional days or upgrades are not covered. Acute inpatient stays require a $295 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require Medicare-defined cost-sharing.
Outpatient Services See details
Molina Medicare Choice Care (HMO) covers outpatient services with no coinsurance, featuring a $0 to $500 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse services require a $40 copay per session with no coinsurance.
Partial Hospitalization See details
Molina Medicare Choice Care (HMO) covers partial hospitalization services with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Molina Medicare Choice Care (HMO) covers ground and air ambulance services with a 20% coinsurance and no copay, which require prior authorization and do not waive coinsurance upon hospital admission. Transportation services are not covered under this plan, as trips to plan-approved and other health-related locations are excluded.
Emergency Services See details
Molina Medicare Choice Care (HMO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $10,000 maximum benefit limit.
Primary Care See details
Molina Medicare Choice Care (HMO) covers primary care and opioid treatment with no copay and no coinsurance, while specialist visits cost a $40 copay and mental health services cost a $45 copay, both with no coinsurance. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Molina Medicare Choice Care (HMO) with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and kidney disease education. Uncovered sub-services include In-Home Safety Assessments, Personal Emergency Response Systems (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, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Molina Medicare Choice Care (HMO) covers hearing services with a $10.00 copay and no coinsurance or deductible for exams. While some services are covered, routine hearing exams, fitting and evaluations, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Molina Medicare Choice Care (HMO) does not cover vision services in practice, as routine eye exams, other eye exams, contact lenses, and eyeglasses are all not covered. While the plan technically lists a $40 copay with no coinsurance for eye exams and no copay with 20% coinsurance for eyewear, no actual services are covered under these benefits.
Dental Services See details
Molina Medicare Choice Care (HMO) partially covers dental services, providing coverage solely for Medicare-covered dental services with a $40.00 copay and no coinsurance. Other dental services, including preventive care like oral exams, cleanings, and x-rays, as well as comprehensive treatments like restorative services and orthodontics, are not covered.
Home Infusion bundled Services See details
Molina Medicare Choice Care (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Molina Medicare Choice Care (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Molina Medicare Choice Care (HMO) with no copay and 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is not covered, as both diabetic supplies and therapeutic shoes or inserts are excluded from coverage.
Diagnostic and Radiological Services See details
Molina Medicare Choice Care (HMO) partially covers diagnostic and radiological services, requiring prior authorization but charging no copays for covered services. Diagnostic procedures and tests have no coinsurance, while diagnostic and therapeutic radiological services require a 20% coinsurance; however, lab services and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Molina Medicare Choice Care (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Molina Medicare Choice Care (HMO) with no copay and no coinsurance, requiring prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Molina Medicare Choice Care (HMO) with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $145 daily copay for days 21 through 100, but additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are partially covered by Molina Medicare Choice Care (HMO), featuring a meal benefit with no copay and no coinsurance following surgery, hospitalization, or for chronic conditions. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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