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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 2025, 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 Michigan. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $9.80. 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 $590.00 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 $9350.00 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 has a $590 deductible for prescription drugs. During the initial coverage phase, you will pay 25% coinsurance for most drugs, but specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $9.80.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including primary care, outpatient, and preventive services, have a 20% coinsurance. Emergency, urgently needed, and diagnostic services have no copay, and some services like home health and home infusion bundled services are covered. The plan also includes coverage for hearing, vision, and dental services, with specific details on exams, eyewear, and dental procedures. Additionally, the plan offers an OTC benefit with a maximum of $75 per month, and covers transportation to health-related locations. However, some services like additional hospital days, home safety assessments, and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Molina Medicare Complete Care (HMO D-SNP) plan, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. Copays apply for covered services, but the exact amount is not specified.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance. Individual and group sessions for outpatient substance abuse services have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Medicare Complete Care (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for up to 30 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. For Emergency and Urgently Needed Services, there is a 20% coinsurance, and no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.
Primary Care See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers primary care services with a 20% coinsurance. Chiropractic services, including routine care, are covered with a 20% coinsurance. The plan also covers occupational therapy, physician specialist services, physical therapy, and speech-language pathology services with a 20% coinsurance. Mental health and psychiatric services are covered with a 20% coinsurance, and podiatry services, other health care professional services, and opioid treatment program services are also covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. Kidney disease education, other preventive services, and additional preventive services like health education, personal emergency response systems, nutritional/dietary benefits, additional smoking cessation sessions, fitness benefits, remote access technologies, and the EKG following Welcome Visit are covered, but services like in-home safety assessments and home-based palliative care are not covered. Some services have a 20% coinsurance.
Hearing Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers hearing exams with a coinsurance of at most 20%, as well as routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription hearing aids are partially covered, with coverage for prescription hearing aids of all types every two years, but not for inner ear, outer ear, or over the ear hearing aids. This plan also covers OTC hearing aids.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have a 20% coinsurance, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental services include a 20% coinsurance for Medicare dental services. Other dental services include oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), restorative services (up to 6 fillings per year, up to 2 inlay/onlay, crowns per year), adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery. Orthodontic services are covered up to $3600 per year, while maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B insulin drugs, there is a $35 copay with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. There is a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Medicare-covered Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services, but you may have to pay up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the cost-sharing details are not provided. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit. OTC items have a maximum benefit coverage of $75.00 every month, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone as an OTC benefit. The Meal Benefit requires prior authorization. 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 are not covered.
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