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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.
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 Select Counties in Utah. This plan received an overall rating of 3 out of 5 stars in 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 $18.30. 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 $9250.00 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 features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This provides significant savings on common and essential medications. For other prescription tiers, costs are determined by coinsurance at standard pharmacies and standard mail order. You will pay a 10% coinsurance for Tier 2 generic drugs, 20% for Tier 3 preferred brand drugs, and 30% for Tier 4 non-preferred drugs. Tier 5 specialty drugs have a 25% coinsurance for a one-month supply.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers comprehensive medical coverage with no copays for most services, though coinsurance rates apply in several areas. Inpatient hospital stays, home health, and skilled nursing facility care are covered with no copay and no coinsurance. For outpatient services, primary care, emergency care, and diagnostic testing, members will pay no copay but are responsible for a coinsurance ranging from 20% to 30%. The plan also includes valuable supplemental benefits such as routine dental, vision, and hearing exams with no copays, alongside a $250 yearly eyewear allowance. Additionally, members can access unlimited one-way transportation to approved health locations and select over-the-counter items with no copay and no coinsurance. Preventive care services, including annual physical exams and fitness benefits, are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Molina Medicare Complete Care (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Molina Medicare Complete Care (HMO D-SNP), requiring a 20% coinsurance and no copay for both ground and air ambulance trips. The plan also provides unlimited one-way transportation to plan-approved health-related locations with no copay and no coinsurance, although transportation to any health-related location is not covered.
Emergency Services See details
Molina Medicare Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, with the emergency coinsurance waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, up to a maximum benefit limit of $10,000.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist visits, physical therapy, and mental health 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 chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under the Molina Medicare Complete Care (HMO D-SNP) plan are partially covered, offering an annual physical exam, fitness benefits, and health education with no copay and no coinsurance, while services like in-home support, weight management, and alternative therapies are not covered. Kidney disease education, glaucoma screenings, and diabetes self-management training are covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are covered by Molina Medicare Complete Care (HMO D-SNP), which provides one routine hearing exam and fitting evaluation annually with no copay, no deductible, and a 20% coinsurance for the routine exam. Prescription and OTC hearing aids are covered with no copay and no coinsurance, though prescription aids are only partially covered since inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Vision services are partially covered by Molina Medicare Complete Care (HMO D-SNP) because other eye exam services are not covered. The plan covers one routine eye exam annually with no copay and no coinsurance, alongside a $250 yearly eyewear allowance with no copay, featuring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers dental services with no copay and no coinsurance for covered benefits, such as exams, cleanings, fillings, and oral surgery. However, other diagnostic and preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, carry a coinsurance of 0% to 20%, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under Molina Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and equipment may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care (HMO D-SNP) covers diagnostic and radiological services, including lab work, X-rays, and therapeutic radiological services, with a 20% coinsurance and no copay. Prior authorization is required for all of these covered outpatient diagnostic procedures and tests.
Home Health Services See details
Home Health Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers cardiac rehabilitation services with no copay, but prior authorization is required and only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and are subject to a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Molina Medicare Complete Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, 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 partially covered by Molina Medicare Complete Care (HMO D-SNP), featuring acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Acupuncture is limited to 12 treatments per year, prior authorization is required for meal benefits, and highly integrated services for dual eligible SNPs are not covered.
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