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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 2026 to people living in Select counties in ID. 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 $37.60. 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 $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. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled through standard pharmacies or standard mail order. This cost sharing benefit applies to one-month, two-month, and three-month supplies. For other medication categories, your costs are determined by coinsurance at standard retail pharmacies and mail-order services. You will pay a 20% coinsurance for Tier 2 generic and Tier 3 preferred brand drugs, 30% coinsurance for Tier 4 non-preferred drugs, and 25% coinsurance for Tier 5 specialty drugs. Specialty medications are limited to a one-month supply, while other tiers offer up to a three-month supply at these same coinsurance rates.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers comprehensive healthcare coverage with no copays for most services, though coinsurance applies to several medical benefits. Inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance, though prior authorization is required. For outpatient care, specialist visits, emergency services, and medical equipment, you will pay no copay but are responsible for a 20% to 30% coinsurance. This plan also includes supplemental benefits like routine vision care with a $250 annual allowance, hearing aids, and unlimited transportation to approved locations with no copay and no coinsurance. Additionally, over-the-counter items, meal benefits, and Medicare-covered dental services are provided at no cost, though routine dental cleanings and cardiac rehabilitation are not covered. Prior authorization is necessary for many of these specialized services to ensure coverage.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While acute and psychiatric stays are covered, 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 with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under Molina Medicare Complete Care (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Molina Medicare Complete Care (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered with no copay and no coinsurance for unlimited trips to plan-approved locations, while 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 cost-sharing counting toward the plan-level deductible and 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 $10,000 maximum benefit limit.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% to 30% coinsurance. Chiropractic services are partially covered, offering up to 20 routine visits per year with other chiropractic services excluded.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, and nutritional therapy, though sub-services like in-home safety assessments, personal emergency response systems, and weight management programs are not covered. Other services like kidney disease education, glaucoma screenings, and diabetes self-management training are covered with no copay and a 20% coinsurance.
Hearing Services See details
Molina Medicare Complete Care (HMO D-SNP) covers hearing exams with no copay and a 20% coinsurance for routine annual exams. Hearing aid fittings, OTC hearing aids, and prescription hearing aids are covered with no copay and no coinsurance, though prescription hearing aids are partially covered since inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) offers partially covered vision services with no copay and no coinsurance, which includes one routine eye exam per year and up to $250 annually for contacts, eyeglasses, and upgrades. Other eye exam services are not covered under this plan.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) covers Medicare-covered dental services with no copay and no coinsurance. However, other dental and orthodontic services, including oral exams, cleanings, x-rays, and restorative services, 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 is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from 0% (no coinsurance) to 20%, with insulin also requiring a $35.00 copay.
Dialysis Services See details
Dialysis services are covered by 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 medical equipment—including durable medical equipment, prosthetics, medical supplies, and diabetic equipment—with no copay and a 20% coinsurance. Prior authorization is required for these services, and some 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 with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
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
Cardiac Rehabilitation Services are not covered in practice under Molina Medicare Complete Care (HMO D-SNP), although the plan technically indicates some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, and any applicable services require a 30% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While standard SNF services are covered without requiring a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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