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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 2026, 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 Counties: Cop,Hin,Is,Lke,Mad,Ran,Sct,Shk,Sim,Yaz. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $4.10. 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 $615.00 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 $9250.00 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 features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs. This no copay benefit applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. For other prescription tiers, costs are determined by coinsurance at standard pharmacies and standard mail order. You will pay a 20% coinsurance for Tier 2 generic and Tier 3 preferred brand drugs, and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most services, including inpatient hospital stays, primary care visits, and specialist consultations. While there are no copays for these visits, many outpatient services, specialist care, and emergency services require a coinsurance ranging from 20% to 30%. Essential benefits like home health care, skilled nursing facilities, and unlimited transportation to plan-approved locations are fully covered with no copay and no coinsurance. For routine wellness, the plan provides preventive and comprehensive dental care, hearing exams, and fitness benefits with no copay and no coinsurance. Vision services are also covered with no copay, though a 20% coinsurance applies to routine exams and contact lenses, alongside a $200 annual allowance for eyewear. Additionally, members can access over-the-counter items and home infusion services with no copay and no coinsurance.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit does not cover additional hospital days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and a 30% coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which require prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Molina Medicare Complete Care (HMO D-SNP) with a 30% coinsurance and no copay, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services also require a 30% coinsurance and no copay, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $10,000 maximum limit.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and coinsurance ranging from 20% to 30%. Chiropractic services are partially covered, offering up to 12 routine visits per year while excluding other chiropractic services.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) provides partially covered preventive services with no copay and no coinsurance for annual physicals and fitness benefits, while kidney disease education and other screenings carry no copay and a 20% coinsurance. Excluded from coverage are in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Molina Medicare Complete Care (HMO D-SNP) covers hearing exams with no copay and no coinsurance, except for routine exams which require a 20% coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear types are not covered, while OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) covers vision services with no copays, though a 20% coinsurance applies to routine eye exams (limited to one per year) and contact lenses, while other eye exam services are not covered. There is no deductible, and the plan provides a combined maximum coverage of $200 per year for eyewear, including lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Molina Medicare Complete Care (HMO D-SNP), featuring Medicare-covered dental care with no copay and 30% coinsurance, and preventive and comprehensive dental care with no copay and no coinsurance. While many treatments are covered, other diagnostic services, other preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission with less than a three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Molina Medicare Complete Care (HMO D-SNP), featuring over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The meal benefit requires prior authorization and is available for chronic illnesses or immediately following surgery or hospitalization.
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