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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 Washington State. 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 $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 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 $9200.00 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) prescription drug plan has an annual drug deductible of $615. Beneficiaries will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. For other medication tiers, cost sharing is determined by coinsurance at standard pharmacies and standard mail order. You will pay 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. These rates apply to both standard retail and standard mail-order options.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers comprehensive medical coverage with no copays for inpatient hospital stays, skilled nursing facility care, and home health services. Outpatient services, diagnostic tests, dialysis, and durable medical equipment also feature no copay, though they generally require a 20% coinsurance. Emergency and primary care services are covered with no copay and a 30% coinsurance, and emergency cost-sharing counts toward the plan-level deductible. This plan provides strong supplemental benefits, including preventive and comprehensive dental care with no copay and no coinsurance up to a $1,000 annual limit. Vision and hearing services also feature no copay or coinsurance, offering routine exams, an annual eyewear allowance of $250, and unlimited over-the-counter hearing aids. Additionally, members can access over-the-counter items and meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. Additional days, non-Medicare-covered stays, and upgrades for acute stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copays and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Molina Medicare Complete Care (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. While transportation is listed as covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Molina Medicare Complete Care (HMO D-SNP) with a 30% coinsurance and no copay (waived if admitted within 24 hours), and cost-sharing counts toward the plan-level deductible. Urgently needed services also carry a 30% coinsurance and no copay, while worldwide emergency, urgent, and transportation services are covered up to $10,000 with no copay and no coinsurance.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and 30% coinsurance (20% to 30% for telehealth and opioid treatment). Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance for annual physical exams and additional preventive benefits, while kidney disease education and specific screenings carry no copay but a 20% coinsurance. Excluded services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services offered by Molina Medicare Complete Care (HMO D-SNP) include annual hearing exams and fitting evaluations with no copay, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear hearing aids are not covered. Unlimited OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam per year and a $250 annual maximum allowance for eyewear, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance for covered preventive and comprehensive care, up to a $1,000 annual maximum. Services that are not covered under this plan include other diagnostic and preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Molina Medicare Complete Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
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
Medical equipment benefits under Molina Medicare Complete Care (HMO D-SNP) are covered with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for these services, and selection may be limited to preferred vendors and manufacturers.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care (HMO D-SNP) covers diagnostic and radiological services—including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays—with no copay and a 20% coinsurance. Prior authorization is required for all of these covered diagnostic and radiological services.
Home Health Services See details
Molina Medicare Complete Care (HMO D-SNP) covers Home Health Services 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 and prior authorization required, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered and require a 30% coinsurance.
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. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered benefit 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 and other miscellaneous services are not covered under this benefit.
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