A non-government entity
Molina Dual MI Coordinated Health (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Dual MI Coordinated Health (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 Dual MI Coordinated Health (HMO D-SNP) in 2026, please refer to our full plan details page.
Molina Dual MI Coordinated Health (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2026 to people living in Macomb and Wayne Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Molina Dual MI Coordinated Health (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 Dual MI Coordinated Health (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 Dual MI Coordinated Health (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 Dual MI Coordinated Health (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 $100.00 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:
Sign up for Molina Dual MI Coordinated Health (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Molina Dual MI Coordinated Health (HMO D-SNP) plan features an annual drug deductible of $100 and offers excellent cost savings on several drug tiers. Beneficiaries will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This coverage applies to one-month, two-month, and three-month supplies, making everyday maintenance medications highly accessible. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copayments. You can expect a 20% coinsurance for Tier 3 preferred brand drugs and a 30% coinsurance for Tier 4 non-preferred drugs at standard pharmacies and standard mail order. Tier 5 specialty drugs require a 31% coinsurance for a one-month supply.
Additional Benefits
The Molina Dual MI Coordinated Health (HMO D-SNP) plan offers medical coverage with no copays for many essential services, including inpatient hospital stays, skilled nursing facility care, and home health services, which all feature no coinsurance. For outpatient hospital services, diagnostic tests, dialysis, and durable medical equipment, members will pay no copay and a 20% coinsurance. Emergency and urgently needed care are also covered with no copay, subject to a 30% coinsurance. Primary care visits, specialist consultations, and physical therapy require no copay alongside a 30% coinsurance. Routine preventive exams, fitness benefits, and over-the-counter items are fully covered with no copays and no coinsurance. While Medicare-covered dental, vision, and diagnostic hearing services are available with no copays, routine dental, routine vision, and hearing aids are not covered under this plan.
Inpatient Hospital See details
Molina Dual MI Coordinated Health (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services, with the cost of the first three pints being waived.
Partial Hospitalization See details
Partial hospitalization services are covered by Molina Dual MI Coordinated Health (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) partially covers ambulance and transportation services, offering Medicare-covered ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) covers emergency services with a 30% coinsurance and no copay, up to $115 per visit, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 30% coinsurance and no copay up to $40 per visit, while worldwide emergency, urgent, and transportation services are fully covered up to a $10,000 maximum with no copay and no coinsurance.
Primary Care See details
Molina Dual MI Coordinated Health (HMO D-SNP) covers primary care, specialist, physical therapy, and mental health services with no copay and a 30% coinsurance. Chiropractic services are partially covered with routine and other chiropractic care excluded, podiatry is not covered, and telehealth and opioid treatment services require a 20% to 30% coinsurance with no copay.
Preventive Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) provides partially covered preventive services, offering annual physical exams, fitness benefits, and home safety assessments with no copay and no coinsurance, though services like medical nutrition therapy and counseling are not covered. Other covered services, including kidney disease education and glaucoma screenings, feature no copay but require a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Molina Dual MI Coordinated Health (HMO D-SNP), which offers diagnostic hearing exams with no copay and no coinsurance. Routine hearing exams, fitting evaluations, OTC hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Molina Dual MI Coordinated Health (HMO D-SNP) with no copay, no deductible, and a 20% coinsurance. However, only some services are covered in practice, as routine eye exams, other eye exam services, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) partially covers dental services, offering coverage for Medicare-covered dental care with no copay and a 20% coinsurance. Routine dental services, such as exams, cleanings, x-rays, fluoride treatments, and orthodontic services, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Molina Dual MI Coordinated Health (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Molina Dual MI Coordinated Health (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Dual MI Coordinated Health (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, 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 Dual MI Coordinated Health (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. These covered services include outpatient diagnostic procedures, lab services, X-rays, and therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Molina Dual MI Coordinated Health (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) provides Cardiac Rehabilitation Services with no copay, though some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 30% coinsurance. Prior authorization is required for these rehabilitation benefits.
Skilled Nursing Facility (SNF) See details
Molina Dual MI Coordinated Health (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan does not require a prior three-day inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Molina Dual MI Coordinated Health (HMO D-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required to access the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved