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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 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 South Carolina. 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 $39.80. 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:
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Drug Coverage
The Molina Medicare Complete Care (HMO D-SNP) plan has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $39.80 for Part D. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, like preventive care, have no copay, while others have a 20% coinsurance, including outpatient services, primary care, and hearing exams. The plan also covers dental, vision, and hearing services, along with medical equipment and home health services. The plan provides coverage for emergency services, ambulance services, and home infusion bundled services. However, some services like inpatient hospital, additional home health hours, and certain dental and vision services require prior authorization. The plan also offers some coverage for OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. However, additional days for inpatient hospital, non-Medicare covered stays, and upgrades for inpatient hospital acute are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and outpatient blood services have a 20% coinsurance, while outpatient substance abuse services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance Services are covered with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation Services are partially covered, with coverage for any health-related location, but not for plan-approved health-related locations.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Emergency Services has a maximum per visit amount of $110.00, while Urgently Needed Services has a maximum per visit amount of $45.00. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.00.
Primary Care See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, occupational therapy services, physical therapy and speech-language pathology services, and chiropractic services have a 20% coinsurance, while individual and group sessions for mental health specialty services, and psychiatric services also have a 20% coinsurance.
Preventive Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers preventive services, including an annual physical exam, with no copay or coinsurance. Kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with a 20% coinsurance. Other services like In-Home Safety Assessment, Medical Nutrition Therapy, and several others are not covered.
Hearing Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, routine hearing exams once per year, and fitting/evaluation for hearing aids once per year. Prescription hearing aids are partially covered, with only "Prescription Hearing Aids (all types)" being covered (2 every two years), while inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are covered, with a quantity of 2 every two years.
Vision Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $200 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered. Orthodontic services are covered with a maximum benefit of $1000 per year, and other services like restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered, but require prior authorization. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
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 is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with prior authorization, while Diabetic Equipment and Prosthetics/Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, but Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the copay information is not provided.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, but does not cover Acupuncture, 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, or Self-Directed Personal Assistance Services. OTC items are covered, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage. Meal benefits are covered but require prior authorization.
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