A non-government entity
Molina Medicare Complete Care Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Medicare Complete Care Plus (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 Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Molina Medicare Complete Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Counties: LA, SD, Riv. and S. Bernardino. The overall rating for this plan is not yet available for 2025.
It's important to know that Molina Medicare Complete Care Plus (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 Plus (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 Plus (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 Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $1.60. 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:
Sign up for Molina Medicare Complete Care Plus (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Molina Medicare Complete Care Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on their tier, until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you will pay $1.60 for Part D drugs. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Molina Medicare Complete Care Plus (HMO D-SNP) plan offers a variety of benefits with cost-sharing requirements. Many services, including outpatient services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facility services, are covered with a 20% coinsurance. The plan also covers transportation services to health-related locations (up to 12 one-way trips per year) with no copay, and home health services with no copay or coinsurance. This plan also offers coverage for emergency services, OTC items (up to $100 monthly), and nicotine replacement therapy. However, some services such as cardiac rehabilitation and additional hours of care are not covered. Prior authorization is required for some services, such as inpatient hospital, partial hospitalization, ambulance and transportation services, and home health services.
Inpatient Hospital See details
Inpatient Hospital coverage, including acute and psychiatric, is covered with prior authorization, but the specific cost-sharing details (copay and coinsurance) are not provided. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance with a waived 3-pint deductible. Ambulatory Surgical Center Services and Outpatient Substance Abuse Services also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year, with no copay. 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 Molina Medicare Complete Care Plus (HMO D-SNP), with a 20% coinsurance for Emergency and Urgently Needed Services, and a maximum benefit of $10,000 for Worldwide Emergency Services. There is no copay for Emergency Services or Urgently Needed Services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered.
Primary Care See details
The Molina Medicare Complete Care Plus (HMO D-SNP) plan covers 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, but does not cover Podiatry Services. Most services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Molina Medicare Complete Care Plus (HMO D-SNP) plan covers preventive services including an annual physical exam, health education, kidney disease education, and fitness benefits. Glaucoma screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits have a 20% coinsurance. However, In-Home Safety Assessments, Personal Emergency Response Systems, 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services, including routine hearing exams and fitting/evaluation for hearing aids, are covered with a coinsurance of at most 20%. Prescription Hearing Aids (all types) and OTC hearing aids are covered, and the plan covers up to 2 hearing aids every two years. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have a 20% coinsurance, and eyewear has a combined maximum of $200 per year.
Dental Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers dental services with 20% coinsurance for Medicare dental services. Other dental services include oral exams, dental x-rays, cleaning, fluoride treatment, orthodontics, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery, while maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B insulin drugs, you will pay a $35 copay and between 0% and 20% coinsurance, and for Medicare Part B chemotherapy/radiation and other drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Molina Medicare Complete Care Plus (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Molina Medicare Complete Care Plus (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with coinsurance. Diabetic Equipment is covered with a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Molina Medicare Complete Care Plus (HMO D-SNP) plan. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you will pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Complete Care Plus (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Molina Medicare Complete Care Plus (HMO D-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan charges the Medicare-defined cost share for tier 1, and additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other services include coverage for over-the-counter (OTC) items, with a maximum benefit coverage of $100.00 every month, and nicotine replacement therapy is offered. However, acupuncture, meal benefits, 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 are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved