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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 2025 to people living in Select Counties in Michigan. 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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 a $425.00 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 prescription drug deductible of $425. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, carrying a $2 copay for a one-month supply and a $4 copay for a two- or three-month supply. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. You will pay a 20% coinsurance for Tier 3 preferred brands and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty tier drugs require a 25% coinsurance for a one-month supply, with these standard cost-sharing rates applying to both standard retail pharmacies and standard mail-order services.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers robust medical coverage featuring no copays for most essential services, including inpatient hospital stays, primary care, and specialist visits. While members benefit from no copays on these services, a 20% to 30% coinsurance applies to outpatient care, emergency services, and doctor visits. Additionally, critical services like home health care and skilled nursing facility stays are covered with no copay and no coinsurance. For supplemental care, this plan provides valuable dental, vision, and hearing benefits with no copays, though a 20% coinsurance applies to routine eye exams and Medicare-covered dental services. Members also enjoy no copay and no coinsurance for routine preventive services, over-the-counter items, and up to 12 one-way transportation trips per year to plan-approved locations. Furthermore, diagnostic services, medical equipment, and dialysis are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered, as 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—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copayments. A 20% coinsurance applies to these covered services, and prior authorization is required for most.
Partial Hospitalization See details
Partial hospitalization is covered under Molina Medicare Complete Care (HMO D-SNP) with no copay and a 30% coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance, though 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 the emergency coinsurance waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a maximum of $10,000 with no copay and no coinsurance.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist visits, and mental health services with no copays and a 30% coinsurance. Telehealth, podiatry, and opioid treatment are also covered with no copays and a 20% to 30% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) covers annual physical exams and select additional preventive services, such as fitness and nutritional benefits, with no copay and no coinsurance, though some services like weight management and in-home safety assessments are not covered. Kidney disease education and other screenings, including glaucoma and diabetes self-management, are covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Molina Medicare Complete Care (HMO D-SNP), featuring routine exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription and OTC hearing aids are available with no copay or coinsurance, though prescription inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) offers partially covered vision services with no copays or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan covers one routine eye exam per year and up to $200 annually for eyewear like glasses and contacts, while other eye exam services are not covered.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $4,000 annual limit. Excluded from coverage are other diagnostic and preventive services, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan 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 benefits, and coverage 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 includes coverage for lab services, diagnostic procedures, outpatient X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care (HMO D-SNP) indicates that some services are covered for cardiac rehabilitation with no copay and a 30% coinsurance, subject to prior authorization. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Molina Medicare Complete Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. A three-day prior hospital stay is not required for admission, but additional days beyond the standard 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 eligible meal benefits with no copay and no coinsurance. Acupuncture is not covered, and prior authorization is required for the meal benefit.
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