A non-government entity
Senior Whole Health Medicare Complete Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health 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 Senior Whole Health Medicare Complete Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Senior Whole Health 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 Counties: Brx, Ki, Nas, NY, Or, Qu, Ric, Roc, West. The overall rating for this plan is not yet available for 2026.
It's important to know that Senior Whole Health 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:
Senior Whole Health 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 Senior Whole Health 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 Senior Whole Health 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 $199.00 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 Senior Whole Health Medicare Complete Care (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 Senior Whole Health Medicare Complete Care (HMO D-SNP) plan features an annual drug deductible of $199. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard mail order. For Tier 2 generic drugs, costs are highly affordable with a $2 copay for a one-month supply and a $4 copay for two- or three-month supplies. For higher-tier medications, the plan utilizes coinsurance for standard pharmacy and mail-order prescriptions. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance for up to a three-month supply. Specialty medications in Tier 5 are covered with a 27% coinsurance for a one-month supply.
Additional Benefits
The Senior Whole Health Medicare Complete Care (HMO D-SNP) plan offers comprehensive coverage featuring no copays for major services like inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, diagnostic tests, dialysis, and primary or specialist visits, members will pay no copay alongside a coinsurance typically ranging from 20% to 30%. Prior authorization is required for many of these medical services, but key benefits like inpatient stays and home health care also feature no coinsurance. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care, acupuncture, and over-the-counter items with no copay and no coinsurance. Members can take advantage of unlimited one-way transportation to approved medical locations at no cost, as well as a $350 annual eyewear allowance with no deductible. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, while hearing aids are available with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Senior Whole Health Medicare Complete Care (HMO D-SNP), offering acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers outpatient services—including hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for most outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan with no copay and a 30% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Additionally, the plan provides unlimited one-way transportation to plan-approved health-related locations with no copay and no coinsurance, though transportation to non-approved health-related locations is not covered.
Emergency Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, both of which count toward the plan-level deductible. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit limit of $10,000.
Primary Care See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers primary care, specialist, and therapy services with no copay and a 20% to 30% coinsurance, though prior authorization is required for several benefits. Chiropractic services are only partially covered because routine chiropractic care is not covered, while routine podiatry is covered for up to six visits per year.
Preventive Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) provides partially covered preventive services, offering no copay and no coinsurance for Medicare-covered zero-dollar benefits, fitness programs, and health education, while kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and post-welcome-visit EKGs require a $0 copay and 20% coinsurance. Sub-services that are not covered under this plan include annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home or bathroom safety devices, and counseling.
Hearing Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers hearing exams with no copay, no deductible, and a 20% coinsurance for routine annual exams, as well as OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers vision services with no copays, featuring a 20% coinsurance for routine eye exams (one per year) and contact lenses. While other eye exam services are not covered, the plan offers a $350 annual allowance for eyewear, including contact lenses, eyeglasses, frames, and upgrades with no deductible.
Dental Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) dental services are partially covered, as orthodontics is not covered. Covered Medicare dental services have no copay and a 20% coinsurance, while other preventive and comprehensive dental services are available with no copay and no coinsurance.
Home Infusion bundled Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Related Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Senior Whole Health Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under Senior Whole Health Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and some items may be limited to preferred brands or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Senior Whole Health Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered services include outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Senior Whole Health Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, though only some services are covered. Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Senior Whole Health Medicare Complete Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Senior Whole Health Medicare Complete Care (HMO D-SNP), including acupuncture (up to 30 treatments per year) and over-the-counter items with no copay and no coinsurance. Meal benefits and highly integrated services for dual eligibles are not covered under this 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