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 2026, 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 Counties: Imp, LA, Riv, SBD, SD. This plan received an overall rating of 3 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $3600.00 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 Choice Care (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay a $12 copay for preferred generics and a $47 copay for standard generics at standard pharmacies and standard mail. For higher-tier drugs, the plan requires a 35% coinsurance for preferred brands, a 33% coinsurance for non-preferred drugs, and no copay for specialty tier drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Part D prescription drugs. Additionally, if you qualify for the low-income subsidy, your Part D premium may be reduced to zero dollars. Be sure to review the plan's formulary to confirm coverage for your specific medications.
Additional Benefits
Molina Medicare Choice Care (HMO) offers comprehensive healthcare coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and annual preventive exams. Specialist visits require a $40 copay, while inpatient hospital stays cost a $325 daily copay for the first six days and no copay for days seven through 90. Emergency room visits carry a $100 copay, which is waived if you are admitted, and urgent care services require a $25 copay. This plan also includes valuable supplemental benefits, such as routine vision exams and over-the-counter hearing aids with no copay or coinsurance. Dental services are covered up to a $4,000 annual limit with a $20 copay for Medicare-covered dental care, and unlimited transportation to plan-approved locations is available at no cost. Additionally, many diagnostic services, medical equipment, and dialysis require a 20% coinsurance with no copay.
Inpatient Hospital See details
Molina Medicare Choice Care (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 to 6 of acute stays and no copay for days 7 to 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Molina Medicare Choice Care (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and outpatient blood services. Other outpatient benefits require copayments, including $0 to $500 for outpatient hospital services, $325 per stay for observation services, and $40 per session for outpatient substance abuse treatment.
Partial Hospitalization See details
Partial hospitalization is covered by Molina Medicare Choice Care (HMO) with a $70 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Molina Medicare Choice Care (HMO), as transportation to any health-related location is not covered. Ground and air ambulance services require a 20% coinsurance and no copay, while unlimited transportation to plan-approved locations is covered with no copay or coinsurance.
Emergency Services See details
Molina Medicare Choice Care (HMO) covers emergency services with a $100 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $10,000 maximum plan benefit.
Primary Care See details
Molina Medicare Choice Care (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and mental health sessions require a $45 copay, both with no coinsurance. Occupational, physical, and speech therapies are covered with a $30 copay and no coinsurance, but podiatry and routine chiropractic care are not covered.
Preventive Services See details
Molina Medicare Choice Care (HMO) covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar preventive exams and annual physicals. The benefit is partially covered, excluding services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Molina Medicare Choice Care (HMO) covers hearing exams with a $10 copay and no coinsurance, alongside unlimited over-the-counter hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Molina Medicare Choice Care (HMO), including one routine eye exam every year with no deductible, no copay, and no coinsurance. Eyewear is covered up to a $350 annual limit with no deductible or copay, featuring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Molina Medicare Choice Care (HMO), with covered Medicare dental services requiring a $20 copay and no coinsurance. While many dental services are covered up to a $4,000 annual maximum, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Molina Medicare Choice Care (HMO) and require prior authorization and step therapy. Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under Molina Medicare Choice Care (HMO) with a 20% coinsurance and no copay.
Medical Equipment See details
Molina Medicare Choice Care (HMO) partially covers medical equipment, providing durable medical equipment, prosthetic devices, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
Molina Medicare Choice Care (HMO) diagnostic and radiological services are partially covered, with outpatient X-ray services being not covered. Covered diagnostic tests and lab services require no copay and up to 20% coinsurance, diagnostic radiological services require a copay of up to $225 and no coinsurance, and therapeutic radiological services require a copay and up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Molina Medicare Choice Care (HMO) subject to prior authorization, though specific copay and coinsurance costs are not specified.
Cardiac Rehabilitation Services See details
Molina Medicare Choice Care (HMO) requires prior authorization and states that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Consequently, there are no copays or coinsurance for these non-covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Molina Medicare Choice Care (HMO), requiring prior authorization and excluding additional days beyond Medicare-covered care. There is no coinsurance for these services, featuring no copay for days 1 through 20 and a $200 daily copay for days 21 through 100.
Other Services See details
Other services are partially covered by Molina Medicare Choice Care (HMO), which offers over-the-counter items and meal benefits with no copay or coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered, and prior authorization is required for the meal benefit.
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