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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 Imperial County. 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 $29.00. 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 the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase. If you qualify for the low-income subsidy, the plan's premium may be reduced to $29.00 per month. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a wide range of benefits, with a focus on both inpatient and outpatient services, including hospital stays, substance abuse treatment, and emergency care. Many services come with a 20% coinsurance, including outpatient services, primary care, hearing, vision, and dental. This plan also includes additional benefits like transportation to health-related locations, over-the-counter items, and a meal benefit, with some services requiring prior authorization.
Inpatient Hospital See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but the cost sharing is not specified. Additional days, upgrades, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance with a waived deductible for the first three pints of blood. Individual and group sessions for outpatient substance abuse have a coinsurance of 20%.
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, including ground and air ambulance services, with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year, with no copay, and a variety of transportation modes are available. However, 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. For Emergency Services and Urgently Needed Services, there is a 20% coinsurance, and no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, and Physician Specialist Services have a 20% coinsurance. Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a coinsurance of 20%. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Occupational Therapy Services and Opioid Treatment Program Services have a minimum and maximum coinsurance of 20%. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, with no copay. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits are covered with 20% coinsurance. Other services like In-Home Safety Assessment, Medical Nutrition Therapy, and others 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, and Fitting/Evaluation for Hearing Aid. Prescription Hearing Aids are partially covered, with only Prescription Hearing Aids (all types) covered, and OTC Hearing Aids are covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to one per year. Eyewear, including contact lenses, eyeglasses, lenses, frames, and upgrades, also have a 20% coinsurance, with a combined maximum benefit of $200 per year for all eyewear.
Dental Services See details
Dental services are covered, with a 20% coinsurance. Oral exams are covered up to two times per year, dental x-rays are covered up to a limited amount, prophylaxis (cleaning) and fluoride treatments are covered up to two times per year, and orthodontics services have a maximum benefit of $500 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered, and maxillofacial prosthetics, implant services, prosthodontics (fixed), 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 coinsurance between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Diabetic Equipment with 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, and Prosthetic Devices with 20% coinsurance; Durable Medical Equipment for use outside the home is not covered. There is no copay for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay, and coinsurance is at most 20% for diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray 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 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 by the Molina Medicare Complete Care (HMO D-SNP) plan, but not covered in practice. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF stays 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 with a maximum benefit of $45.00 every month, including nicotine replacement therapy and Naloxone coverage. The plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. The plan covers a meal benefit with prior authorization.
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