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 2026, 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 2026 to people living in Select counties in TX. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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:
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) prescription drug plan features an annual drug deductible of $615. Enrollees enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, requiring a $2 copay for a one-month supply and a $4 copay for two- or three-month supplies. For higher-tier medications, costs are based on coinsurance rather than flat copayments. Standard pharmacies and mail-order services charge a 20% coinsurance for Tier 3 preferred brand drugs and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance, including inpatient hospital stays, home health care, and skilled nursing facility services. For outpatient care, primary and specialist visits, emergency services, and diagnostic testing, members will pay no copay and a coinsurance ranging from 20% to 30%. Preventive care and annual physicals are fully covered with no copay and no coinsurance, helping you manage your health at no extra cost. This plan also includes key supplemental benefits like dental, vision, and hearing coverage, which generally require no copay but may have a 20% coinsurance for specific services. Additionally, members receive everyday support with no copay and no coinsurance for up to 12 one-way transportation trips, select over-the-counter items, and acupuncture treatments. Most specialized services and durable medical equipment require prior authorization and carry a standard 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered for acute or psychiatric care.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services with no copayments and a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Molina Medicare Complete Care (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Molina Medicare Complete Care (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Molina Medicare Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, which counts toward the plan-level deductible. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $10,000 maximum limit with no copay and no coinsurance.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist visits, and outpatient therapy services with no copay and a 30% coinsurance, though routine chiropractic services are not covered. Routine podiatry is covered with a 20% coinsurance for up to 6 visits per year, and opioid treatment programs are available with no copay and no coinsurance.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) covers preventive services and annual physical exams with no copay and no coinsurance, though additional preventive benefits are only partially covered, excluding services such as in-home safety assessments, alternative therapies, and weight management programs. Kidney disease education, glaucoma screenings, and diabetes self-management training are also covered with no copay but require a 20% coinsurance.
Hearing Services See details
Hearing services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay for exams and hearing aids, though routine hearing exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every two years, but inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) provides partially covered vision services, which include one routine eye exam per year with no copay and a 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay up to a $200 annual limit, with a 20% coinsurance applying specifically to contact lenses.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) provides partially covered dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, and other covered services with no copay and no coinsurance. Specific services not covered under this plan include implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B drugs, including chemotherapy and radiation, require a 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Molina Medicare Complete Care (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and some equipment may be limited to preferred manufacturers or vendors.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care (HMO D-SNP) covers diagnostic and radiological services, including lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, subject to prior authorization. There is no copay for these services, but a 20% coinsurance applies.
Home Health Services See details
Home Health Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and require prior authorization. However, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While standard Medicare-covered days do not require a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Molina Medicare Complete Care (HMO D-SNP), featuring acupuncture, over-the-counter (OTC) items, and limited-duration meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture, which is limited to 20 treatments per year, and meal benefits, while other select services are not covered.
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