A non-government entity
Molina Medicare Choice Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Medicare Choice Care (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Molina Medicare Choice Care (HMO) in 2025, please refer to our full plan details page.
Molina Medicare Choice Care (HMO) is a HMO plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Select Counties in California. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Molina Medicare Choice Care (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Molina Medicare Choice Care (HMO).
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 Choice Care (HMO), 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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 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 Choice Care (HMO)
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Drug Coverage
The Molina Medicare Choice Care (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions, with the amount varying based on the drug tier and pharmacy type. For preferred generic drugs, the copay is $12 at standard and mail-order pharmacies. For standard generic drugs, the copay is $47, and for preferred brand drugs, the copay is $100. Non-preferred drugs have a 33% coinsurance, and specialty tier drugs have no copay.
Additional Benefits
The Molina Medicare Choice Care (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, while outpatient services have copays depending on the service. Emergency services have a copay, and ambulance services have coinsurance. This plan also covers primary care, preventive, hearing, vision, and dental services with copays or coinsurance. Additionally, it includes home health, skilled nursing, and cardiac rehabilitation services. The plan also covers home infusion bundled services, dialysis, and medical equipment, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric does not list any cost information, but the plan does state that additional days and non-medicare covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $500, observation services with a $325 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services. Outpatient substance abuse services include individual and group sessions, both with a copay of $40. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Medicare Choice Care (HMO) plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for all ambulance services. Ground and Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are covered, while Transportation Services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Molina Medicare Choice Care (HMO) plan. Emergency Services have a $100 copay with no coinsurance, Urgently Needed Services have a $25 copay with no coinsurance, and Worldwide Emergency Services have a maximum plan benefit coverage of $10,000.
Primary Care See details
The Molina Medicare Choice Care (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $40 copay, mental health specialty services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The Molina Medicare Choice Care (HMO) plan covers preventive services including health education, nutritional/dietary benefits (up to 12 visits), additional sessions of smoking and tobacco cessation counseling (up to 8 visits), fitness benefits, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $10 copay, fitting/evaluation for hearing aids, and OTC hearing aids. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all of which have a 20% coinsurance for contact lenses and a combined maximum benefit of $200 per year.
Dental Services See details
The Molina Medicare Choice Care (HMO) plan covers dental services, including oral exams with a $20 copay, and offers coverage for dental x-rays, prophylaxis (cleaning), and fluoride treatments. Orthodontic services are covered up to a maximum of $1600 per year, and some restorative, adjunctive general, endodontic, periodontic, prosthodontics (removable), and oral and maxillofacial surgery services are covered with prior authorization. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Molina Medicare Choice Care (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered under the Molina Medicare Choice Care (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests and lab services, with a coinsurance of up to 20%, and diagnostic radiological services and therapeutic radiological services, with a maximum copay of $225 and a coinsurance of up to 20%, respectively. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Choice Care (HMO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay information can be found below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $200. 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 and meal benefits, with acupuncture, 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 not covered. Over-the-counter items are covered, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone as a Part C OTC benefit. Meal benefits require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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