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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 Virginia. This plan received an overall rating of 2.5 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 $6.70. 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. If you qualify for the low-income subsidy, you will pay $6.70 for Part D drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including preventive services, are covered with no copay. However, you'll typically encounter a 20% coinsurance for outpatient services, primary care, hearing, vision, dental, ambulance, emergency services, and many other services. The plan also covers inpatient hospital stays, home health services, and dialysis services with coinsurance. Additional benefits include coverage for over-the-counter items up to $50 per month, a meal benefit, and transportation services, which may require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered for the Molina Medicare Complete Care (HMO D-SNP) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, the plan charges the Medicare-defined cost share for tier 1, with coinsurance details available.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered by the Molina Medicare Complete Care (HMO D-SNP) plan, with a 20% coinsurance. Outpatient blood services are also covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all services. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. 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. Emergency Services and Urgently Needed Services have a 20% coinsurance, and 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 Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a 20% coinsurance, while Occupational Therapy Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, and Psychiatric Services also have a 20% coinsurance.
Preventive Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are covered, as are health education, personal emergency response systems, nutritional/dietary benefits, and fitness benefits, with various sub-services covered and some requiring 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%, and also covers routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids (all types) are covered, limited to two every two years, while OTC hearing aids are also covered. However, prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to one per year. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, also have a 20% coinsurance with a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan, with a 20% coinsurance for Medicare dental services, and coverage for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is 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 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, each with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any service. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan, but the plan does not cover any of the sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan, but require prior authorization. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers over-the-counter items up to $50 per month, including nicotine replacement therapy and naloxone. 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. The plan also covers a meal benefit, but prior authorization is required.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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