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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 Select counties in Illinois. 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)
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 Dual Options (Medicare-Medicaid Plan) has a $0 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once 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 range of benefits with varying cost structures. Many services, including ambulance, emergency, dialysis, medical equipment, home health, and diagnostic services, are covered with no copay. Preventive services include coverage for Medicare-covered services, with no copay, as well as additional services like Health Education, Nutritional/Dietary Benefit (up to 12 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling (up to 8 visits), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan also covers outpatient services, hearing services, vision services, dental services (up to $600 per year), and home infusion services. Additionally, it provides coverage for skilled nursing facility services with no copay, as well as additional days beyond Medicare-covered. Other benefits include an OTC allowance of $60 every three months and coverage for a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Additional days and non-Medicare-covered stays for both acute and psychiatric services are covered, while upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered by the Molina Dual Options (Medicare-Medicaid Plan), including all Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, but Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Molina Dual Options (Medicare-Medicaid Plan). All ambulance services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance, but transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, are covered by the Molina Dual Options (Medicare-Medicaid Plan) with no copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The Molina Dual Options (Medicare-Medicaid Plan) plan covers primary care physician services, chiropractic services (excluding routine chiropractic care), occupational therapy, physician specialist services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services are not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, with no copay, as well as additional services like Health Education, Nutritional/Dietary Benefit (up to 12 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling (up to 8 visits), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, fitness benefits, 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 routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. The plan covers routine hearing exams and fitting/evaluation for hearing aids as medically necessary, and prescription hearing aids (all types) are covered once every three years. Inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Molina Dual Options (Medicare-Medicaid Plan) plan covers vision services including eye exams and eyewear. Routine eye exams are limited to one per year, and other eye exam services and contact lenses are covered as medically necessary. Eyeglasses (lenses and frames) are covered once every two years, and eyeglass lenses are covered as medically necessary; however, eyeglass frames and upgrades are not covered.
Dental Services See details
The Molina Dual Options (Medicare-Medicaid Plan) plan covers dental services, with a maximum benefit of $600 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, but they are limited to a certain number of visits per year. Orthodontic services and implant services 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, although Chemotherapy/Radiation Drugs are not covered. Prior authorization is required, and the plan does not have a service-specific maximum out-of-pocket cost.
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) and Prosthetics/Medical Supplies - Non-Medicare benefit, both with no copay and no coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment benefits require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the Molina Dual Options (Medicare-Medicaid Plan) with no copay and no coinsurance. However, 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 by the Molina Dual Options (Medicare-Medicaid Plan), including additional days beyond Medicare-covered, and non-Medicare-covered stays. Prior authorization is required, and there is no copay.
Other Services See details
The Molina Dual Options (Medicare-Medicaid Plan) plan does not cover acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. This plan covers Over-the-Counter (OTC) Items with a maximum benefit of $60 every three months, and it also covers a meal benefit, Institution for Mental Disease Services for Individuals 65 or Older, Tobacco Cessation Counseling for Pregnant Women (up to 12 sessions per year), Other 1 (Hospice), Other 2 (Behavioral Health), Other 3 (Telehealth), Other 4 (Emergency Dental), Other 7 (Medication Assisted Treatment (MAT)), Other 8 (Crisis Services (Expanded), up to 30 days following an MCR event), Other 9 (Gender-Affirming Services), and Nursing Home Services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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