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 2025, 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 2025.
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 $57.60. 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 a $125.00 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 Choice Care (HMO) plan has a $125 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred and standard generics, you will pay a $12 or $47 copay, respectively. Preferred brand drugs have a $100 copay, while non-preferred drugs have a 31% coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The Molina Medicare Choice Care (HMO) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay for the first few days, and outpatient services may have copays ranging from $0 to $500. Emergency and urgent care services have set copays, and ambulance services require coinsurance. This plan includes coverage for primary care, preventive services with no copay, and some vision and dental services, each with associated copays or coinsurance. Additional benefits include home health services with no copay, and coverage for dialysis services with 20% coinsurance. The plan also covers some medical equipment and diagnostic services with coinsurance, but excludes certain services like hearing aids, and many dental and vision services.
Inpatient Hospital See details
Inpatient Hospital coverage with the Molina Medicare Choice Care (HMO) plan includes a copay of $295 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric is also covered. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $500, and observation services with a $295 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Medicare Choice Care (HMO) plan, but requires prior authorization. The plan has a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Molina Medicare Choice Care (HMO) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Molina Medicare Choice Care (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services have a maximum plan benefit coverage of $10,000.
Primary Care See details
The Molina Medicare Choice Care (HMO) plan covers primary care physician services, chiropractic services with 20% coinsurance for routine care, occupational therapy services with a $35 copay, physician specialist services with a $40 copay, and mental health specialty services with a $45 copay for individual and group sessions. The plan also covers other health care professional services with a copay between $0 and $40, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The Molina Medicare Choice Care (HMO) plan covers preventive services including annual physical exams, health education, kidney disease education services, and other preventive services, with no copay or coinsurance. The plan also covers nutritional/dietary benefits (12 visits), additional sessions of smoking and tobacco cessation counseling (8 visits), fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following the Welcome Visit. However, In-Home Safety Assessment, Personal Emergency Response System (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 are not covered.
Hearing Services See details
Hearing Services are covered by the Molina Medicare Choice Care (HMO) plan, with hearing exams costing a $10 copay, while routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision Services are covered, including eye exams with a $40 copay, but routine eye exams are not covered. Eyewear is also covered, with a 20% coinsurance for contact lenses, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered under the Molina Medicare Choice Care (HMO) plan, with a $40 copay for Medicare Dental Services. However, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Molina Medicare Choice Care (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Molina Medicare Choice Care (HMO). Diagnostic Procedures/Tests have a coinsurance of at most 20% and no copay, while Lab Services are not covered. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20% and no copay, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Choice Care (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Molina Medicare Choice Care (HMO) plan, but not covered in practice, as the plan does not cover any of the associated sub-services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Molina Medicare Choice Care (HMO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
Other Services, including acupuncture, over-the-counter items, meal benefits, and other services, are not covered by the Molina Medicare Choice Care (HMO) plan. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and other services are not covered.
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