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Molina One Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina One 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 One Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Molina One Care (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2026 to people living in Select counties in MA. The overall rating for this plan is not yet available for 2026.
It's important to know that Molina One 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 One 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 One 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 One Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.50. 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 $615.00 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 $1500.00 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 One Care (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. You will need to pay this deductible amount out-of-pocket before your plan begins covering the costs of your prescription medications. Specific drug coverage tier details, including copayments and coinsurance rates, are not available for this plan. To determine your exact prescription costs, you should consult the plan's formulary to see how your specific medications are categorized and covered.
Additional Benefits
The Molina One Care (HMO D-SNP) plan provides coverage for core medical needs with no copays for inpatient hospital stays, primary care, and outpatient services. Instead of copays, most services require coinsurance, such as 20% for outpatient care, diagnostic tests, and ambulance services, or 30% for specialist visits and partial hospitalization. Emergency and urgent care services also require no copay, charging a 30% coinsurance up to set maximum limits of $115 and $40, which apply to the plan deductible. For specialty care, the plan covers Medicare-covered vision and dental services with no copay and a 20% coinsurance, while covered hearing exams feature no copay and no coinsurance. Home health care and skilled nursing facility tier-one days are fully covered with no copay and no coinsurance. However, routine services like glasses, hearing aids, and dental cleanings are not covered, and extra benefits such as over-the-counter items, fitness programs, and meal deliveries are excluded.
Inpatient Hospital See details
Inpatient hospital services are covered by Molina One Care (HMO D-SNP) with no copay, though prior authorization is required and Medicare-defined coinsurance applies. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Molina One Care (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Prior authorization is required for most outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under Molina One Care (HMO D-SNP) with no copay and a 30% coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered by Molina One Care (HMO D-SNP) with a 20% coinsurance and no copay for both ground and air transport, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Molina One Care (HMO D-SNP) covers emergency services with a 30% coinsurance and no copay up to a $115 maximum, and urgently needed services with a 30% coinsurance and no copay up to a $40 maximum, with both counting toward the plan deductible. While worldwide emergency services are technically covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered in practice.
Primary Care See details
Molina One Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 30% coinsurance, while chiropractic and podiatry services are not covered. Opioid treatment program services feature no copay and no coinsurance, and telehealth benefits are available with no copay and 0% to 30% coinsurance.
Preventive Services See details
Molina One Care (HMO D-SNP) covers Medicare-covered zero-dollar preventive services with no copay and no coinsurance, while kidney disease education and other services like glaucoma screenings and diabetes training have no copay and a 20% coinsurance. Annual physical exams and additional preventive services, including fitness benefits and home safety assessments, are not covered.
Hearing Services See details
Hearing services are partially covered by Molina One Care (HMO D-SNP), offering covered hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, hearing aid fittings or evaluations, and all prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Molina One Care (HMO D-SNP) covers vision services with no copay, a 20% coinsurance, and no deductible. While some services are covered, routine eye exams, other eye exams, contact lenses, eyeglasses, and upgrades are not covered.
Dental Services See details
Molina One Care (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Other dental services, including preventive care, diagnostic services, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Molina One Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Molina One Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under Molina One Care (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and certain manufacturer or vendor limitations may apply.
Diagnostic and Radiological Services See details
Molina One Care (HMO D-SNP) covers diagnostic and radiological services with no copayment, although a 20% coinsurance and prior authorization are required for all services. This coverage includes diagnostic procedures, lab work, x-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Molina One Care (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Molina One Care (HMO D-SNP) with no copay, though some services are covered while others are not. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 30% coinsurance with prior authorization required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Molina One Care (HMO D-SNP) with no coinsurance and no copay for tier 1 days, though prior authorization is required. The plan does not require a three-day prior inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Molina One Care (HMO D-SNP) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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