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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 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 Plus (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 Northwestern counties in IL. CMS star rating not available for 2026.
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 $0.00. 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
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 Plus (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 Plus (HMO D-SNP) features an annual prescription drug deductible of $615. Members enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order. This ensures that essential everyday medications remain highly accessible and affordable. For other prescription tiers, costs are determined by a percentage of the drug cost through coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 20% coinsurance, Tier 4 non-preferred drugs require a 30% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. This clear cost-sharing structure helps you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Molina Medicare Complete Care Plus (HMO D-SNP) offers robust medical coverage featuring no copays for the vast majority of covered services. Core benefits such as inpatient hospital care, skilled nursing facilities, home health services, and plan-approved transportation are fully covered with no copay and no coinsurance. For outpatient care, specialist visits, emergency services, and medical equipment, members will pay no copay but are responsible for a coinsurance ranging from 20% to 30%. This plan also includes valuable supplemental benefits designed to lower out-of-pocket healthcare expenses. Dental care is covered with no copay and no coinsurance up to a $4,000 annual limit, and vision benefits provide up to a $250 yearly allowance for eyewear. Furthermore, members can take advantage of over-the-counter items, post-discharge meals, and hearing aids with no copays.
Inpatient Hospital See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered, as additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers ambulance and transportation services, though transportation is partially covered as trips to non-approved health-related locations are not covered. Ground and air ambulance services require prior authorization and carry a 20% coinsurance with no copay, while unlimited one-way rides to plan-approved locations are provided with no copay and no coinsurance.
Emergency Services See details
Emergency services are covered under Molina Medicare Complete Care Plus (HMO D-SNP) with a 30% coinsurance and no copay, which does not count toward the deductible and is waived if admitted to the hospital within 24 hours. Urgently needed services also carry a 30% coinsurance and no copay, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $10,000 maximum.
Primary Care See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers primary care, specialist visits, therapy, and telehealth services with no copays and coinsurance ranging from 20% to 30%. Chiropractic services are partially covered, providing up to 20 routine visits per year while other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and no coinsurance for annual exams, while kidney education and select screenings require a 20% coinsurance and no copay. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers hearing services with no copays for exams, OTC hearing aids, and prescription hearing aids, though routine hearing exams carry a 20% coinsurance. Prescription hearing aids are partially covered with no coinsurance, but inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Molina Medicare Complete Care Plus (HMO D-SNP), offering one routine eye exam per year with no copay and a 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, a 20% coinsurance for contact lenses, and a combined maximum benefit of $250 every year.
Dental Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $4,000 annual limit. Non-covered services under this plan include other diagnostic services, other preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Part B chemotherapy, radiation, and other Part B drugs carry no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and certain vendor or manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers diagnostic and radiological services, requiring prior authorization. There is no copay for these services, but a 20% coinsurance applies to all Medicare-covered diagnostic procedures, lab services, radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and require prior authorization. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered in practice and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copayment or coinsurance, although prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and other miscellaneous services under this benefit category are not covered.
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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