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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) 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 pharmacies or standard mail order. Tier 2 generic and Tier 3 preferred brand medications require a 20% coinsurance for one-, two-, or three-month supplies. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 30% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply at standard pharmacies and mail order. This plan provides clear cost-sharing tiers to help you manage your prescription drug expenses.
Additional Benefits
Molina Medicare Complete Care (HMO D-SNP) offers robust medical coverage featuring no copays for inpatient hospital stays, skilled nursing facility care, and doctor visits. While most services eliminate copays entirely, members should expect a 20% coinsurance for outpatient care, primary care visits, and medical equipment, alongside a 30% coinsurance for specialists and emergency services. Additionally, prior authorization is required for several key benefits, including inpatient admissions and diagnostic services. Routine preventive care, home health services, and over-the-counter items are fully covered with no copays and no coinsurance. However, routine dental and vision benefits are extremely limited or not covered, although Medicare-covered dental care and routine hearing exams are available for a $25 copay. Hearing aids are also covered with no copay, providing valuable savings on essential assistive devices.
Inpatient Hospital See details
Molina Medicare Complete Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. However, this plan does not cover upgrades, additional hospital days, or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services under Molina Medicare Complete Care (HMO D-SNP) are covered with no copays, but feature a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Molina Medicare Complete Care (HMO D-SNP) 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, requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Molina Medicare Complete Care (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, which both count toward the plan-level deductible. Worldwide emergency, urgent, and 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) covers primary care physician services with no copay and 20% coinsurance, and specialist visits with no copay and 30% coinsurance. Chiropractic benefits are partially covered with no copay or coinsurance for up to 12 routine visits per year, while other chiropractic services and podiatry services are not covered.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) covers preventive services, including annual physical exams and select additional benefits with no copay and no coinsurance, though sub-services like in-home safety assessments and personal emergency response systems are not covered. Covered kidney disease education and other screenings, such as glaucoma and diabetes self-management training, require no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are covered by Molina Medicare Complete Care (HMO D-SNP) with no deductible, featuring routine exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance, as inner ear, outer ear, and over the ear models 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) vision services are not covered in practice, as key sub-services like routine eye exams, contact lenses, and eyeglasses are not covered. Although the plan technically lists no copay and a 20% coinsurance with no deductible for vision care, no individual services are actually covered.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) partially covers dental services, with coverage limited to Medicare-covered dental services for a $25 copay and no coinsurance. All other dental services, including exams, cleanings, x-rays, restorative care, and orthodontic services, 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, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, require coinsurance ranging from no coinsurance to 20%, with insulin drugs also having a copay of $35.
Dialysis Services See details
Molina Medicare Complete Care (HMO D-SNP) covers dialysis services 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 for these benefits, and coverage may be limited to preferred vendors or specific 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. This benefit covers Medicare-approved lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Molina Medicare Complete Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Molina Medicare Complete Care (HMO D-SNP) with no copay, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation 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, and the plan does not require a prior three-day inpatient hospital stay for admission. Prior authorization is required, and 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 a meal benefit with no copay and no coinsurance. Prior authorization is required for the meal benefit, while acupuncture, highly integrated services for dual eligibles, and other additional services are not covered.
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