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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 2026 to people living in New Mexico State. The overall rating for this plan is not yet available for 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 $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 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) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard retail pharmacies or standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies of these medications. For other prescription tiers, costs are covered through coinsurance at standard pharmacies and standard mail order. You will pay 20% coinsurance for Tier 2 generic and Tier 3 preferred brand drugs, 30% coinsurance for Tier 4 non-preferred drugs, and 25% coinsurance for Tier 5 specialty drugs. Coinsurance rates apply to one, two, and three-month supplies, with Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers robust medical coverage with no copay and no coinsurance for essential services like inpatient hospital stays, home health care, and skilled nursing facility visits. For outpatient hospital services, diagnostic tests, and durable medical equipment, members can expect no copay and a 20% coinsurance. Primary care visits require no copay and a 20% coinsurance, while specialist visits and emergency services carry a 30% coinsurance. This plan also features key supplemental benefits, including dental coverage with no copay up to a $3,000 annual limit and routine vision care with a $125 annual eyewear allowance and a 20% coinsurance. Routine hearing exams require a $25 copay, while hearing aids and over-the-counter items are covered with no copay. Additionally, the plan offers up to 12 free one-way transportation trips per year to plan-approved health locations with no copay and no coinsurance.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization are required for outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are also covered with no copay and a 20% coinsurance, with the deductible waived for the first three pints.
Partial Hospitalization See details
Partial hospitalization is covered under the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and a 30% coinsurance. Prior authorization is required to receive these services.
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, subject to prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Molina Medicare Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, with the emergency coinsurance waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and emergency transportation services are also covered up to a $10,000 maximum limit with no copay and no coinsurance.
Primary Care See details
Molina Medicare Complete Care (HMO D-SNP) primary care benefits feature no copays for covered services, with 20% coinsurance for primary care visits and 30% coinsurance for specialists, mental health, psychiatric, and therapy services. Chiropractic care is partially covered, offering up to 12 routine visits per year with no copay and no coinsurance, while other chiropractic and podiatry services are not covered. Opioid treatment program services are covered with no copay and no coinsurance.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) offers partially covered preventive services, providing annual physical exams and select wellness benefits with no copay and no coinsurance, while sub-services like in-home safety assessments, PERS, and medical nutrition therapy are not covered. Kidney disease education and other screenings, such as glaucoma and diabetes self-management, are covered with no copay and a 20% coinsurance.
Hearing Services See details
Molina Medicare Complete Care (HMO D-SNP) covers annual routine hearing exams with a $25 copay and no coinsurance, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers vision services with no copay, no deductible, and a 20% coinsurance for routine eye exams and contact lenses. This benefit includes a $125 annual allowance for eyewear, frames, lenses, and upgrades, though other eye exam services are not covered.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) provides partially covered dental services, requiring a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual limit. Services that are not covered under this plan include other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Molina Medicare Complete Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required, and coverage may be limited to specified manufacturers or preferred vendors.
Diagnostic and Radiological Services See details
Molina Medicare Complete Care (HMO D-SNP) covers diagnostic and radiological services with no copay, though a 20% coinsurance and prior authorization are required. This coverage includes diagnostic procedures, lab services, outpatient X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and require prior authorization, though only some services are covered. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are 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 without a prior three-day hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture and highly integrated services are not covered under this benefit.
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