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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 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:
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Drug Coverage
The Molina Medicare Complete Care (HMO D-SNP) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 6 select care drugs, you will pay no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs are also highly affordable, requiring only a $2 copay for a one-month supply and a $4 copay for two- or three-month supplies. For higher-tier medications, costs are structured as coinsurance. Standard pharmacy and mail order fills for Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance. Tier 5 specialty drugs require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers comprehensive coverage with no copays for most medical services, though coinsurance rates typically range from 20% to 30%. Key healthcare services like inpatient hospital stays, outpatient care, primary care, and specialist visits feature no copay, but coinsurance and prior authorization are often required. Additionally, emergency services, ambulance rides, and diagnostic testing are covered with no copay and a 20% to 30% coinsurance. For supplemental care, the plan provides dental, vision, and hearing benefits with no copays, featuring up to $3,600 annually for dental services and a $200 yearly eyewear allowance. Home health care, skilled nursing facilities, and select preventive services are fully covered with no copays and no coinsurance. Other valuable additions include over-the-counter items, meal benefits, and up to 12 one-way transportation trips per year at no cost to the member.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay, though Medicare-defined coinsurance and prior authorization are required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Molina Medicare Complete Care (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, providing up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is 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, both of which count toward the plan-level deductible. Worldwide emergency, urgent, and transportation services are also covered up to a $10,000 maximum with no copay and no coinsurance.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, and therapy services with no copay and 30% coinsurance. Opioid treatment is covered with no copay and no coinsurance, routine podiatry is covered with no copay and 20% coinsurance for up to six visits per year, and chiropractic services are not covered in practice as routine and other chiropractic sub-services are excluded.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) provides partially covered preventive services with no copay and either no coinsurance or a 20% coinsurance depending on the specific service. Covered benefits such as annual physicals, fitness programs, and personal emergency response systems have no copay and no coinsurance, whereas kidney education, glaucoma screenings, diabetes training, digital rectal exams, and post-welcome EKGs carry a 20% coinsurance and no copay. Non-covered services include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Molina Medicare Complete Care (HMO D-SNP) covers hearing exams with no copay and no deductible, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance, excluding inner ear, outer ear, and over the ear models, while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) vision services are partially covered with no deductibles or copays, although a 20% coinsurance applies to routine eye exams and contact lenses. The plan covers one routine exam annually and provides up to $200 per year for eyewear, but other eye exam services are not covered.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, alongside other dental services with no copay and no coinsurance up to a $3,600 annual maximum. Uncovered sub-services include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Molina Medicare Complete Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, are covered with no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
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 medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Prior authorization is required for these covered services, which include diagnostic procedures, lab work, X-rays, and therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Molina Medicare Complete Care (HMO D-SNP) with no copay and require prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Molina Medicare Complete Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan does not require a prior three-day inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers other services, providing acupuncture (up to 20 treatments per year), over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while highly integrated services for dual eligibles and other miscellaneous services are not covered.
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