A non-government entity
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 Select Counties in Texas. This plan received an overall rating of 3 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 $8.30. 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:
Sign up for Molina 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 Molina Medicare Complete Care (HMO D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you will pay 25% coinsurance for most drugs, but no copay for specialty tier drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan may also have a reduced premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a variety of benefits with cost-sharing requirements. Many services, including outpatient, partial hospitalization, ambulance, primary care, preventive, vision, dental, home infusion, dialysis, medical equipment, and diagnostic services, involve a coinsurance of up to 20%. This plan also provides some services with no copay, such as home health and diagnostic and radiological services. The plan covers hearing services with a coinsurance of at most 20%, offers coverage for OTC items with a maximum benefit, and provides meal benefits under certain circumstances.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days and non-Medicare-covered stays for both are not covered, and upgrades for Inpatient Hospital-Acute are not covered. The cost share is defined by original Medicare.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while the plan covers outpatient blood services with a 20% coinsurance and waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Medicare Complete Care (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. For Emergency and Urgently Needed Services, you will pay 20% coinsurance and no copay. Worldwide Emergency Services has a maximum benefit coverage of $10,000.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Occupational Therapy Services, Mental Health Specialty Services (Individual and Group Sessions), Podiatry Services (Routine Foot Care), Other Health Care Professional, Psychiatric Services (Individual and Group Sessions) are covered, but have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers preventive services including annual physical exams, kidney disease education services, and other preventive services. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with 1 visit every year. Prescription hearing aids are partially covered, but not for inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are covered, with a quantity of 2 every two years.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Eye exams and eyewear have a 20% coinsurance, and the plan offers a combined maximum of $200 per year for eyewear.
Dental Services See details
Dental services are covered, with a 20% coinsurance. Oral exams are covered, up to 2 per year, and dental x-rays are covered, up to 1 per year, as well as prophylaxis (cleaning) and fluoride treatment, both up to 2 per year. Orthodontic services are covered up to a maximum of $1,000 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered, but maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0% and 20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered by this plan. Durable Medical Equipment (DME) and Diabetic Supplies have a 20% coinsurance, while Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. All diagnostic and radiological services have no copay, while diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services 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 or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit, and coinsurance may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Molina Medicare Complete Care (HMO D-SNP), but require prior authorization. This plan does not cover additional days beyond Medicare-covered SNF or non-Medicare-covered SNF stays.
Other Services See details
Other services include acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture requires prior authorization and is limited to 20 treatments per year. OTC items are covered with a maximum benefit of $30.00 per month, and meal benefits are provided under certain circumstances, but require prior authorization. The plan does not cover 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.
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