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Molina Dual Options (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Molina Dual Options (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Molina Dual Options (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
Molina Dual Options (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Wayne and Macomb Counties. The overall rating for this plan is not yet available for 2025.
It's important to know that Molina Dual Options (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Molina Dual Options (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Molina Dual Options (Medicare-Medicaid Plan).
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 Dual Options (Medicare-Medicaid Plan), 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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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 Dual Options (Medicare-Medicaid Plan)
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Drug Coverage
The Molina Dual Options (Medicare-Medicaid Plan) has an enhanced alternative drug benefit. There is no deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay no copay for your Part D drugs. After your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Molina Dual Options (Medicare-Medicaid Plan) offers a wide range of benefits with a focus on low-cost care. Many services have no copay, including inpatient and outpatient hospital stays, ambulance and transportation, emergency services, primary care, preventive services, home health, dialysis, medical equipment, and diagnostic services. This plan covers hearing and vision services, and also includes dental coverage. The plan provides additional benefits like home infusion, over-the-counter items with a monthly allowance, and a meal benefit. However, some services are not covered, such as worldwide emergency coverage, cardiac rehabilitation, and certain dental, vision, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, including additional days, with no copay or coinsurance, and Inpatient Hospital Psychiatric, which requires prior authorization, with no copay or coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Molina Dual Options (Medicare-Medicaid Plan), including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, with a doctor referral required for blood services; however, individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services have a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this service.
Ambulance and Transportation Services See details
The Molina Dual Options (Medicare-Medicaid Plan) covers ambulance and transportation services, with no copay or coinsurance for all ambulance services. Transportation Services - Any Health-related Location is covered, with no copay or coinsurance, and includes round trip taxi, rideshare services, bus/subway, van, medical transport, and other transportation options. Ground and air ambulance services, and transportation services to a plan-approved health-related location, are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Molina Dual Options (Medicare-Medicaid Plan). There is no copay or coinsurance for Emergency Services or Urgently Needed Services. However, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with no copay and no coinsurance. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services are partially covered, and do not cover Routine Chiropractic Care, Individual Sessions, or Group Sessions for Mental Health Specialty Services and Psychiatric Services. Podiatry Services are covered, including Routine Foot Care, with 6 visits allowed per year.
Preventive Services See details
The Molina Dual Options (Medicare-Medicaid Plan) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services like Health Education, Nutritional/Dietary Benefit (12 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling (8 visits), Fitness Benefit (Physical Fitness, Memory Fitness), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered, including hearing exams and prescription hearing aids. Fitting/evaluation for hearing aids is covered for up to two visits every year, and prescription hearing aids (all types) are covered every 5 years.
Vision Services See details
The Molina Dual Options plan covers vision services, including routine eye exams with one visit every two years, contact lenses (1 pair per year), eyeglasses (lenses and frames) with one pair per year, eyeglass lenses (1 pair per year), and eyeglass frames (1 frame per year). Upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Molina Dual Options (Medicare-Medicaid Plan), including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Prosthetics/Medical Supplies have no copay and no coinsurance, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Molina Dual Options (Medicare-Medicaid Plan), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Molina Dual Options (Medicare-Medicaid Plan) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Molina Dual Options (Medicare-Medicaid Plan). Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, including additional days beyond Medicare coverage, and the plan allows for stays without a 3-day inpatient hospital stay. Non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a monthly maximum of $25, and a meal benefit, with no copay or coinsurance. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance 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
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