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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 Select counties in OH. This plan received an overall rating of 3 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 $29.70. 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. After you meet your deductible, you will pay the costs associated with your drugs until your total drug costs reach $2,000. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), you may have a reduced Part D premium of $29.70.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, including preventive services, diagnostic and radiological services, and home health services, have no copay. However, you'll likely encounter coinsurance for services such as outpatient, emergency, and primary care, typically at 20%. The plan also covers hearing, vision, and dental services, along with home infusion and dialysis services. The plan offers additional coverage such as ambulance and transportation services, and other services like acupuncture, over-the-counter items, and meal benefits are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for acute care are not covered. You will have a copay for these services, and prior authorization is required.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance with a waived three-pint deductible, and outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Molina Medicare Complete Care (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to any health-related location. Transportation services to a plan-approved health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under 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
Molina Medicare Complete Care (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance, while mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a coinsurance of 20%.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education, and more. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have a 20% coinsurance, while the other services have no cost sharing.
Hearing Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers hearing exams with at most a 20% coinsurance, and covers routine hearing exams and fitting/evaluation for hearing aids once per year. The plan also covers prescription hearing aids (all types) with 2 every two years, but does not cover prescription hearing aids for the inner ear, outer ear, or over the ear. This plan also covers OTC hearing aids.
Vision Services See details
Vision services include routine eye exams and eyewear coverage, with a combined maximum benefit of $200. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered, with specific services like 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 being covered. Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, you will pay a $35 copay, and the coinsurance ranges from 0% to 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 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 benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance with no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment have a 20% coinsurance, with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. You may have to pay up to 20% coinsurance for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
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 additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Molina Medicare Complete Care (HMO D-SNP) plan, but require prior authorization. The plan charges the Medicare-defined cost share for tier 1, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Molina Medicare Complete Care (HMO D-SNP) plan covers acupuncture, over-the-counter items, and meal benefits. Acupuncture is covered for up to 12 treatments per year. Over-the-counter items are covered, including nicotine replacement therapy and naloxone. The meal benefit is available following surgery or inpatient hospitalization, for a chronic illness, or for a medical condition requiring the enrollee to remain at home, and requires prior authorization. Services for 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 are not covered.
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