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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Molina Medicare Complete Care (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare of Illinois Inc available for the 2026 plan year to people living in Select counties in NE. CMS star rating not available for 2026.
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 $3.40. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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:
Sign up for Molina Medicare Complete Care (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Molina Medicare Complete Care (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies. For other medication tiers, you will pay a coinsurance percentage instead of a flat copay at standard pharmacies and standard mail order. Tier 2 generic drugs and Tier 3 preferred brand drugs both carry a 20% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance. Specialty drugs in Tier 5 are covered with a 25% coinsurance for a one-month supply.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers comprehensive medical coverage featuring no copays for inpatient hospital stays, primary care visits, and outpatient services. While there are no copays for these essential services, many outpatient, specialist, and emergency care services require coinsurance ranging from 20% to 30%. Additionally, the plan covers worldwide emergency care up to $10,000 and provides unlimited one-way transportation to plan-approved locations with no copay or coinsurance. Members also benefit from preventive care, home health services, and over-the-counter items with no copay and no coinsurance. Dental, vision, and hearing services are partially covered with no copays, though some routine exams and specific devices may require coinsurance or have annual coverage limits. Medical equipment, diagnostic tests, and dialysis are also accessible with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) offers partially covered inpatient hospital services with no copay and no coinsurance, although prior authorization is required. This benefit covers acute and psychiatric hospital stays but excludes additional days, non-Medicare-covered stays, and upgrades.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services with no copays, but a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and a 30% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copayment. Transportation services to plan-approved health-related locations are also covered with no copay or coinsurance for unlimited one-way trips, but transportation to any health-related location is not covered.
Emergency Services See details
Molina Medicare Complete Care (HMO D-SNP) covers emergency and urgent care services with a 30% coinsurance and no copay, which counts toward your plan-level deductible, though emergency coinsurance is waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a maximum benefit of $10,000 with no copay and no coinsurance.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) offers primary care, specialist, mental health, and physical therapy services with no copay and 30% coinsurance, though prior authorization is required for some services. Opioid treatment program services are covered with no copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) covers preventive services, featuring annual physical exams with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management. Kidney disease education and other screenings are covered with no copay and 20% coinsurance.
Hearing Services See details
Hearing services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay for exams, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every two years, excluding inner ear, outer ear, and over the ear models which are not covered. Unlimited OTC hearing aids are also covered with no copay or coinsurance.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers vision services with no copays, including one routine eye exam per year subject to a 20% coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $200 annual limit with no copay, applying a 20% coinsurance for contact lenses and no coinsurance for eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Molina Medicare Complete Care (HMO D-SNP), featuring no copay and 30% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive dental services up to a $1,000 annual limit. Non-covered sub-services include other diagnostic services, other preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs—including chemotherapy, radiation, and insulin—have no coinsurance to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and some equipment may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Molina Medicare Complete Care (HMO D-SNP) with no copay, but require prior authorization and a 20% coinsurance. This coverage applies to all diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered under Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and requires prior authorization, but some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Molina Medicare Complete Care (HMO D-SNP) with no coinsurance and Medicare-defined copayments, requiring prior authorization but no prior three-day hospital stay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture is not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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