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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 Gila, Maricopa, Pinal. This plan received an overall rating of 3.5 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 $6.20. 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 $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your Part D cost will be $6.20. After meeting your deductible, you will pay the costs for drugs in each tier. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs, but you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a range of services with varying cost-sharing. Many services, like primary care, specialist visits, therapy, and outpatient services, have a 20% coinsurance. Emergency, outpatient, and ambulance services also have a 20% coinsurance. Preventive services, hearing, vision, and dental services are covered with coinsurance or copays, and the plan covers home health services with no copay. The plan also includes coverage for home infusion services, medical equipment, and diagnostic services, with varying cost-sharing, and offers OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Molina Medicare Complete Care (HMO D-SNP) plan, but additional days and non-Medicare-covered stays for both are not covered. Prior authorization is required for both acute and psychiatric inpatient hospital services, and coinsurance applies.
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 for individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by the Molina Medicare Complete Care (HMO D-SNP) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. 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, and Worldwide Emergency Services are covered by the Molina Medicare Complete Care (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a maximum benefit coverage of $10,000.
Primary Care See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers primary care physician services, chiropractic services (including routine care), occupational therapy, physician specialist services, mental health specialty services (including individual and group sessions), other health care professional services, psychiatric services (including individual and group sessions), physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care, specialist, and therapy services have a 20% coinsurance, while chiropractic services also have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services, and additional services like Health Education, Personal Emergency Response System (PERS), Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit; however, Annual Physical Exams, In-Home Safety Assessment, 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, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, and routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are partially covered, with only prescription hearing aids of all types being covered at two every two years; inner ear, outer ear, and over the ear aids are not covered. OTC hearing aids are covered, limited to 2 hearing aids every two years.
Vision Services See details
Vision services include eye exams and eyewear, with a 20% coinsurance for both. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $200 per year, and upgrades are not covered.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare Dental Services. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery, with specific limitations on the number of visits and/or services covered. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan. You will pay a 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, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic, diagnostic radiological, therapeutic radiological, and outpatient X-Ray services. There is no copay for diagnostic services or radiological services, but you may have to pay up to 20% coinsurance.
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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but this plan does not provide SNF services as a supplemental benefit under Part C. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, but does not cover Acupuncture, Meal Benefits, 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, and Self-Directed Personal Assistance Services. The plan offers OTC items, including nicotine replacement therapy (NRT) and Naloxone, as a Part C OTC benefit.
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