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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 Select counties in OH. This plan received an overall rating of 3 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 $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 prescription 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 services. This zero-dollar cost-sharing applies to one-month, two-month, and three-month supply options. For other medication tiers, your costs are determined by coinsurance rather than flat copayments. 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 and are limited to a one-month supply through standard pharmacy or mail order channels.
Additional Benefits
The Molina Medicare Complete Care (HMO D-SNP) plan offers comprehensive medical coverage featuring no copayments for most services, though coinsurance charges do apply in several areas. For outpatient hospital care, diagnostic tests, and durable medical equipment, you will pay a 20% coinsurance with no copay, while primary care, specialist visits, and emergency services carry a 30% coinsurance and no copay. Additionally, inpatient hospital stays are covered with Medicare-defined copayments, while home health and skilled nursing facility services require no copay or coinsurance. This plan also provides robust supplemental benefits, including routine dental care, annual eye exams with a $200 eyewear allowance, and hearing aids with no copay or coinsurance. Members can also access unlimited one-way transportation to plan-approved locations, fitness benefits, and over-the-counter items at no cost. Keep in mind that prior authorization is required for many services, including inpatient care, therapies, and medical equipment.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no coinsurance and Medicare-defined copayments, requiring prior authorization. This benefit does not cover upgrades, additional days, or non-Medicare-covered stays for acute and psychiatric care.
Outpatient Services See details
Molina Medicare Complete Care (HMO D-SNP) covers outpatient services with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is 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
Ambulance and transportation services are partially covered by Molina Medicare Complete Care (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Unlimited one-way transportation to plan-approved locations is covered with no copay and no coinsurance, but 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 (up to $115 per visit, waived if admitted within 24 hours), while urgently needed services require a 30% coinsurance and no copay (up to $40). 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
Primary care benefits under Molina Medicare Complete Care (HMO D-SNP) are generally covered with no copay and a 30% coinsurance, including primary care, specialist, therapy, and mental health services. Routine chiropractic care is partially covered with no copay or coinsurance for up to 12 visits per year, while podiatry services are not covered.
Preventive Services See details
Molina Medicare Complete Care (HMO D-SNP) preventive services are partially covered, offering annual physicals, fitness benefits, and nutritional counseling with no copay and no coinsurance, while kidney disease education and select screenings require no copay and a 20% coinsurance. Sub-services that are not covered include in-home safety assessments, 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, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Molina Medicare Complete Care (HMO D-SNP) covers hearing services, featuring routine hearing exams with no copay and a 20% coinsurance limited to one per year, alongside annual fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every two years, though inner ear, outer ear, and over the ear models are not covered, while over-the-counter (OTC) hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Molina Medicare Complete Care (HMO D-SNP) with no copay and no coinsurance, though other eye exam services are not covered. This benefit includes one routine eye exam per year and up to a $200 annual maximum allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Molina Medicare Complete Care (HMO D-SNP) covers a wide range of preventive and comprehensive dental services with no copay and no coinsurance. However, this benefit is only partially covered, as other diagnostic and 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, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, insulin, and other drugs, feature no coinsurance to 20% coinsurance, with insulin also 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 certain brand or vendor limitations may apply.
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 coverage includes outpatient diagnostic tests, lab services, therapeutic and diagnostic 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Molina Medicare Complete Care (HMO D-SNP) provides cardiac rehabilitation services with no copay and prior authorization required, although some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Molina Medicare Complete Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan does not require a prior three-day inpatient hospital stay for admission, 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 acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Highly integrated services for dual-eligible SNPs and other unspecified services are not covered under this benefit.
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