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Molina Medicare Complete Care Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Medicare Complete Care Plus (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 Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
Molina Medicare Complete Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2026 to people living in Hidalgo County. The overall rating for this plan is not yet available for 2026.
It's important to know that Molina Medicare Complete Care Plus (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 Plus (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 Plus (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 Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $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 $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 Plus (HMO D-SNP) plan features an annual drug deductible of $615. Members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order services. This zero-dollar cost sharing applies to one-month, two-month, and three-month supplies of these medications. For other drug tiers, the plan utilizes coinsurance rather than flat copayments. Tier 2 generic and Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance. Specialty drugs in Tier 5 require a 25% coinsurance for a one-month supply through standard pharmacy or standard mail order channels.
Additional Benefits
Molina Medicare Complete Care Plus (HMO D-SNP) offers comprehensive healthcare coverage with no copay for many essential services, including inpatient hospital stays, home health, and skilled nursing facility care. For outpatient services, primary care, specialist visits, and diagnostic tests, members will pay no copay and a coinsurance ranging from 20% to 30%. Emergency and urgent care services are also covered with no copay and a 30% coinsurance, while worldwide emergency coverage is available with no copay or coinsurance up to a $10,000 limit. This plan also features robust supplemental benefits, including dental care with no copay or coinsurance up to a $4,000 annual limit and routine vision care with up to $250 yearly for eyewear. Additionally, members can access hearing aids, over-the-counter items, meals, and monthly transportation allowances up to $170 with no copay or coinsurance. Medical equipment, dialysis, and routine hearing exams are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Molina Medicare Complete Care Plus (HMO D-SNP), which offers acute and psychiatric hospital stays with no copay or coinsurance, subject to prior authorization. However, additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Molina Medicare Complete Care Plus (HMO D-SNP), with ground and air ambulance requiring a 20% coinsurance and no copay. Transportation benefits are partially covered with no copay and no coinsurance up to $170 monthly for plan-approved locations, though transportation to any health-related location that is not plan-approved is not covered.
Emergency Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers emergency and urgent care services with a 30% coinsurance and no copay, which apply 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 of $10,000.
Primary Care See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers primary care, specialist visits, mental health, and therapy services with no copay and a coinsurance of 20% to 30%. Opioid treatment is covered with no copay and no coinsurance, while chiropractic services are not covered under this plan.
Preventive Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, and personal emergency response systems, while sub-services like in-home support and nutritional therapy are not covered. Other services, including kidney disease education, glaucoma screenings, and diabetes self-management training, are covered with no copay and a 20% coinsurance.
Hearing Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers hearing services with no copays, although routine exams require a 20% coinsurance with no deductible. Prescription hearing aids are partially covered with no copay or coinsurance, excluding inner ear, outer ear, and over the ear types, while OTC hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Molina Medicare Complete Care Plus (HMO D-SNP), featuring no copay and a 20% coinsurance for routine eye exams and contact lenses. The plan covers one routine eye exam and up to $250 for eyewear yearly with no deductible, though other eye exam services are not covered.
Dental Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) features partially covered dental services with no copay and no coinsurance for preventive and most comprehensive care up to a $4,000 annual limit, while Medicare-covered dental has no copay and a 20% coinsurance. Excluded from coverage are other diagnostic and preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage for certain equipment and supplies is limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with prior authorization required. Members will pay no copay and a 20% coinsurance for these covered services.
Home Health Services See details
Home Health Services are covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care Plus (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, although only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this benefit and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Molina Medicare Complete Care Plus (HMO D-SNP) with no copay and no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered under this benefit.
Other Services See details
Other services are partially covered by Molina Medicare Complete Care Plus (HMO D-SNP), which provides acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. While these key benefits are covered (with prior authorization required for acupuncture and meals), dual eligible SNPs with highly integrated services are not covered.
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