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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 NE. 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 $15.60. 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 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan may have a reduced premium if you qualify for the low-income subsidy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. To find the exact costs for your specific drugs, consult the plan's formulary.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient, partial hospitalization, ambulance, emergency, primary care, preventive, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic, and skilled nursing facility services, have a 20% coinsurance. Some preventive services are covered with no copay, and the plan also covers OTC items and meal benefits. The plan covers inpatient hospital stays, but coinsurance details are not provided. Home health services are covered with no copay. Prior authorization is often required for services like partial hospitalization, ambulance, home infusion, cardiac rehabilitation, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered under the Molina Medicare Complete Care (HMO D-SNP) plan, but details on the coinsurance costs are not provided. Additional days, non-Medicare-covered stays, and upgrades for inpatient hospital acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered with a 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with a coinsurance between 20% and 20%. Outpatient blood services are covered with a 20% coinsurance, and three pints are deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Medicare Complete Care (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Molina Medicare Complete Care (HMO D-SNP), with all ambulance services requiring prior authorization and a 20% coinsurance for both ground and air ambulance services. Transportation Services are partially covered, with coverage for any health-related location but not for plan-approved health-related locations.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, with a maximum per visit amount of $110.00 and $45.00 respectively, and Worldwide Emergency Services have a maximum plan benefit coverage of $10,000.00.
Primary Care See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Chiropractic services, occupational therapy services, podiatry services, other health care professional services, psychiatric services, and mental health specialty services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as annual physical exams, additional preventive services, health education, personal emergency response systems, nutritional/dietary benefits with 12 visits, additional sessions of smoking and tobacco cessation counseling with 8 visits, fitness benefits, remote access technologies, kidney disease education services, and other preventive services including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with 20% coinsurance. In-home safety assessment, medical nutrition therapy, 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
The Molina Medicare Complete Care (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20%, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids are partially covered, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, while prescription hearing aids (all types) are covered (2 every two years). OTC hearing aids are also covered.
Vision Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and eyewear have a 20% coinsurance, and contact lenses are subject to a $200 combined maximum benefit per year.
Dental Services See details
Dental services are partially covered by the Molina Medicare Complete Care (HMO D-SNP) plan, with a 20% coinsurance. 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, with prior authorization required. 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 under the Molina Medicare Complete Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and a prior authorization is required; Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medicare-covered Prosthetic Devices, and Medicare-covered Medical Supplies have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%, all with no copay.
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 Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. This plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
Other Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits, but Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered. OTC items include Nicotine Replacement Therapy and Naloxone coverage. Meal Benefits require prior authorization.
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