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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 Bexar, Dallas, El Paso, Harris & Hidalgo 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. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay the costs for your drugs in each tier until your total drug costs reach $2,000. Once you reach that amount, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Molina Dual Options (Medicare-Medicaid Plan) offers comprehensive coverage with many services available at no copay, including primary care, preventive services, and home health services. The plan provides additional benefits like hearing and vision services, including routine exams and coverage for hearing aids, eyeglasses, and contact lenses. Dental services are covered up to $2,000 annually. In addition to these core benefits, the plan covers emergency services, ambulance services, and dialysis services with no cost-sharing. While the plan offers robust coverage, it's important to note some limitations, such as exclusions for certain types of hearing aids, vision upgrades, and specific dental, home health, and medical equipment services. Some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days for Inpatient Hospital-Acute has 30 additional days per benefit period. Additional Days for Inpatient Hospital Psychiatric are unlimited.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, though individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services have an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Dual Options (Medicare-Medicaid Plan) and requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Molina Dual Options (Medicare-Medicaid Plan) with no copay or coinsurance for all ambulance services, but ground and air ambulance services are not covered. Transportation services to any health-related location are also not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Molina Dual Options (Medicare-Medicaid Plan), but Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered. There is no copay or coinsurance for Emergency Services or Urgently Needed Services.
Primary Care See details
Under the Molina Dual Options (Medicare-Medicaid Plan), Primary Care includes coverage for 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, all with no copay and no coinsurance. However, Chiropractic Services and Mental Health Specialty Services do not cover individual or group sessions, and Psychiatric Services do not cover individual or group sessions.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and additional preventive services that cover Health Education, Personal Emergency Response Systems, Weight Management Programs, Fitness Benefits, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Counseling Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following Welcome Visits. The plan does not cover Annual Physical Exams, In-Home Safety Assessments, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, or Home and Bathroom Safety Devices and Modifications. Nutritional/Dietary Benefits are covered with 12 visits. Counseling Services are covered with 30 visits, each lasting 60 minutes.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered once every 5 years, but Inner Ear, Outer Ear, and Over the Ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams every 12 months, and coverage for contact lenses and eyeglasses (lenses and frames), with a limit of one pair of each every two years. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $2,000 every year. 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), oral and maxillofacial surgery, and maxillofacial prosthetics are covered, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin (Medicare Part B Insulin Drugs) is covered under this plan. 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) and Prosthetics/Medical Supplies - Non-Medicare benefit, both with no copay and no coinsurance. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are technically covered, but none of the sub-services are covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Molina Dual Options (Medicare-Medicaid Plan) with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, including additional days beyond Medicare coverage. The plan does not cover non-Medicare-covered stays.
Other Services See details
Other Services include coverage for over-the-counter items with a maximum benefit of $120 every three months, meal benefits that require prior authorization, and several other services. 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, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Family Planning Services, Nursing Home 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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