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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)
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 an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, after you pay 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 array of benefits with a focus on low-cost care. Many services, like primary care, emergency services, and home health services, have no copay. The plan also includes coverage for hearing, vision, and dental services, with a $2,000 annual maximum for dental. This plan provides additional benefits such as coverage for over-the-counter items with a quarterly allowance, and a meal benefit. It also covers inpatient and outpatient services, along with transportation and ambulance services, all with specific limitations. However, be aware that some services like certain hearing aids, and specific dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Additional days for Inpatient Hospital-Acute are covered, with 30 additional days per benefit period, and Additional Days for Inpatient Hospital Psychiatric are covered with no limit. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services are covered, but individual and group sessions for outpatient substance abuse are not covered. Prior authorization is required for these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Dual Options (Medicare-Medicaid Plan) and requires prior authorization. No additional cost information is provided for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Molina Dual Options (Medicare-Medicaid Plan). All ambulance services are covered with prior authorization, and there is no copay or coinsurance. However, ground and air ambulance services are not covered, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered with no copay and no coinsurance. However, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
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, with no copay or coinsurance. Chiropractic Services are partially covered, but Routine Chiropractic Care is not covered. Mental Health Specialty Services and Psychiatric Services are partially covered, but Individual and Group Sessions are not covered. Podiatry Services are covered, with routine foot care offered.
Preventive Services See details
Preventive Services are covered, but 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, and home and bathroom safety devices and modifications are not covered. This plan also covers Health Education, Personal Emergency Response System (PERS), Weight Management Programs, Fitness Benefits, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Nutritional/Dietary Benefit (12 visits), Counseling Services (30 visits), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, all of which are covered with no deductible. Prescription hearing aids are covered, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Molina Dual Options (Medicare-Medicaid Plan) plan covers routine eye exams once every 12 months, and eyewear, including contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Molina Dual Options (Medicare-Medicaid Plan) plan covers a maximum of $2,000 per year for dental services. 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. Medicare Part B Insulin Drugs are covered, while 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 is covered under the Molina Dual Options (Medicare-Medicaid Plan), including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, both with no copay and no coinsurance. 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 covered with no copay, but all services are not covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Molina Dual Options (Medicare-Medicaid Plan) with no copay or coinsurance, but authorization is required. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Molina Dual Options (Medicare-Medicaid Plan), with prior authorization required. Additional days beyond Medicare-covered for SNF are also covered, while non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter items with a maximum benefit of $120.00 every three months, and a meal benefit requiring prior authorization. The plan does not cover acupuncture, 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, Freestanding Birth Center Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, Self-Directed Personal Assistance Services, Tobacco Cessation Counseling for Pregnant Women, and Respiratory Care Services.
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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