A non-government entity
Molina Healthcare, Inc.
Plan ID: H8197-2-2
Plan Summary PageMolina Dual Options (Medicare-Medicaid Plan)
2025 Molina Dual Options (Medicare-Medicaid Plan) H8197 — 002 — 2 is a Medicare Advantage plan with drug coverage. 0
Learn more about Molina Dual Options (Medicare-Medicaid Plan) H8197 - 002 - 2, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
$0.00 /mo
Monthly premium
$0
Drug deductible
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!
Plan Overview
2025 Molina Dual Options (Medicare-Medicaid Plan) H8197 — 002 — 2 is a Medicare-Medicaid Plan offered in Bexar, Dallas, El Paso, Harris & Hidalgo counties by Molina Healthcare, Inc.. It has a monthly premium of $0.00.
Premium Breakdown
Standard Part B Premium
$185.00
Part B premium reduction
- $0
Monthly Plan Premium
$0.00
Total Premium:
$185.00
Note:
The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
No
Out-of-pocket maximum (In-Network)
N/A
Out-of-pocket maximum (Out-of-Network)
N/A
Out-of-pocket maximum (Combined)
N/A
Plan Organization:
Molina Healthcare, Inc.
Plan Type:
Medicare-Medicaid Plan
Location:
Bexar, Dallas, El Paso, Harris & Hidalgo counties
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible
$0
Sign up for Molina Dual Options (Medicare-Medicaid Plan)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Molina Dual Options (Medicare-Medicaid Plan) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$0
Part D Premium Reduction
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
|---|---|
$0.00 | $0.00 |
Initial Coverage Phase
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2000.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | - | - | - | - |
2. Standard Generic | - | - | - | - |
3. Preferred Brand | - | - | - | - |
4. Non-Preferred Drug | - | - | - | - |
5. Specialty Tier | - | - | - | - |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
Molina Dual Options (Medicare-Medicaid Plan) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Enhanced benefits
Non-Medicare-covered Stay
Periodicity
Original Medicare
Additional Days for Inpatient Hospital-Acute
Additional Days for Inpatient Hospital-Acute benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of Additional Days per benefit period
30
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Inpatient Hospital Psychiatric benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Enhanced benefits (1b)
Non-Medicare-covered Stay
Periodicity
Original Medicare
Additional Days for Inpatient Hospital Psychiatric
Additional Days for Inpatient Hospital Psychiatric benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered. Prior Authorization is required.
Observation Services
Observation Services benefits are covered. Prior Authorization is required.
Ambulatory Surgical Center (ASC) Services
Ambulatory Surgical Center (ASC) Services benefits are covered. Prior Authorization is required.
Outpatient Substance Abuse Services
Outpatient Substance Abuse Services benefits are covered. Prior Authorization is required.
Individual Sessions for Outpatient Substance Abuse
Not covered.
Group Sessions for Outpatient Substance Abuse
Not covered.
Outpatient Blood Services
Outpatient Blood Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Enhanced benefit
Three (3) Pint Deductible Waived
Partial Hospitalization
Partial Hospitalization benefits are covered. Prior Authorization is required.
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered. Prior Authorization is required.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Ground Ambulance Services
Not covered.
Air Ambulance Services
Not covered.
Transportation Services
Transportation Services benefits are covered.
Transportation Services - Plan Approved Health-related Location
Not covered.
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment?
No
Urgently Needed Services
Urgently Needed Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment?
No
Worldwide Emergency Services
Worldwide Emergency Services benefits are covered.
Worldwide Emergency Coverage
Not covered.
Worldwide Urgent Coverage
Not covered.
Worldwide Emergency Transportation
Not covered.
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Primary Care Physician Services benefits are covered.
Chiropractic Services
Chiropractic Services benefits are covered.
Routine Chiropractic Care
Not covered.
Occupational Therapy Services
Occupational Therapy Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a coinsurance?
No
Is there a copayment ?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Does this plan provide Non-Medicare-covered Occupational Therapy Services?
Yes
Enter name of Non-Medicare-covered Occupational Therapy Service
Additional Occupational Therapy Services
Is there a service specific maximum plan benefit coverage amount?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Physician Specialist Services
Physician Specialist Services benefits are covered. A doctor referral is required.
Mental Health Specialty Services
Mental Health Specialty Services benefits are covered. Prior Authorization is required.
Individual Sessions for Mental Health Specialty Services
Not covered.
Group Sessions for Mental Health Specialty Services
Not covered.
Podiatry Services
Podiatry Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Enhanced benefits (7f)
Routine Foot Care
Is this benefit unlimited?
No
Visits
12
Periodicity
Every year
Is there a maximum plan benefit coverage amount?
No
Other Health Care Professional
Other Health Care Professional benefits are covered. Prior Authorization is required.
Psychiatric Services
Psychiatric Services benefits are covered. Prior Authorization is required.
Individual Sessions for Psychiatric Services
Not covered.
Group Sessions for Psychiatric Services
Not covered.
Physical Therapy and Speech-Language Pathology Services
Physical Therapy and Speech-Language Pathology Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a coinsurance?
No
Is there a copayment ?
No
Is there a copayment?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Does this plan provide Non-Medicare-covered Physical and/or Speech Therapy services?
Yes
Non-Medicare-covered Physical and/or Speech Therapy Services
Other 1, Other 2
Is there a maximum plan benefit coverage amount?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Other 1 for PT and SP Services
Other 1 for PT and SP Services benefits are covered.
More Details:
Enter name of Other 1 Service
Additional Physical Therapy Services
Other 2 for PT and SP Services
Other 2 for PT and SP Services benefits are covered.
More Details:
Enter name of Other 2 Service
Additional Speech, Hearing & Language Therapy Services
Additional Telehealth Benefits
Additional Telehealth Benefits benefits are covered.
Opioid Treatment Program Services
Opioid Treatment Program Services benefits are covered. Prior Authorization is required.
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam
Not covered.
Additional Preventive Services
Additional Preventive Services benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a service-specific Maximum Plan Benefit Coverage amount for Other Defined Supplemental Benefits?
No
Health Education
Health Education benefits are covered.
In-Home Safety Assessment
Not covered.
Personal Emergency Response System (PERS)
Personal Emergency Response System (PERS) benefits are covered.
Medical Nutrition Therapy (MNT)
Not covered.
Post discharge In-Home Medication Reconciliation
Not covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Weight Management Programs benefits are covered.
Alternative Therapies
Not covered.
Therapeutic Massage
Not covered.
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Nutritional/Dietary Benefit benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
12
Setting for Nutritional/Dietary Benefit
Both Sessions (Individual and Group)
Home-Based Palliative Care
Not covered.
In-Home Support Services
Not covered.
Support for Caregivers of Enrollees
Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling
Not covered.
Fitness Benefit
Fitness Benefit benefits are covered.
More Details:
Type of Fitness Benefit offered
Physical Fitness, Memory Fitness
Enhanced Disease Management
Enhanced Disease Management benefits are covered.
Telemonitoring Services
Telemonitoring Services benefits are covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) benefits are covered.
Home and Bathroom Safety Devices and Modifications
Not covered.
Counseling Services
Counseling Services benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
30
Setting for Counseling Services
Both Sessions (Individual and Group)
Session duration (in minutes)
60
Kidney Disease Education Services
Kidney Disease Education Services benefits are covered.
Other Preventive Services
Other Preventive Services benefits are covered.
More Details:
Is a referral required for any Services?
No
Glaucoma Screening
Glaucoma Screening benefits are covered.
Diabetes Self-Management Training
Diabetes Self-Management Training benefits are covered.
Barium Enemas
Barium Enemas benefits are covered.
Digital Rectal Exams
Digital Rectal Exams benefits are covered.
EKG following Welcome Visit
EKG following Welcome Visit benefits are covered.
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Hearing Exams benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Hearing Exams
Routine Hearing Exams benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Fitting/Evaluation for Hearing Aid
Fitting/Evaluation for Hearing Aid benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Prescription Hearing Aids
Prescription Hearing Aids benefits are covered – including services not usually covered by Medicare plans.
More Details:
Service maximum plan benefit coverage
No
Prescription Hearing Aids (all types)
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Other, Describe
Description
Every 5 years.
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Eye Exams benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Eye Exams
Routine Eye Exams benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Other, Describe
Description
Plan covers eye exams every 12 months.
Eyewear
Eyewear benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Contact Lenses
Contact Lenses benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of pairs
1
Periodicity
Every two years
Eyeglasses (lenses and frames)
Eyeglasses (lenses and frames) benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of pairs
1
Periodicity
Every two years
Eyeglass lenses
Not covered.
Eyeglass frames
Not covered.
Upgrades
Not covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Medicare Dental Services benefits are covered.
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum amount
2000.00
Periodicity
Every year
Oral Exams
Oral Exams benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
1 periodic oral evaluation per 6 months2 limited oral evaluation per date of service1 comprehensive evaluation per 36 months1 evaluation post-op exam per 6 months
Dental X-Rays
Dental X-Rays benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of X-Rays
1
Periodicity
Other, Describe
Description
For periodicity, please see the notes.
Other Diagnostic Dental Services
Other Diagnostic Dental Services benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Pulp vitality tests, diagnostic casts and caries risk assessments. Prior Auth on unspecified diagnostic procedure, by report.
Prophylaxis (Cleaning)
Prophylaxis (Cleaning) benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Every six months
Fluoride Treatment
Fluoride Treatment benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Every six months
Other Preventive Dental Services
Other Preventive Dental Services benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
1 of space maintainer per 24 months per arch or quadrantrepairs not allowed within 6 months of placement
Orthodontic Services
Orthodontic Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum plan benefit coverage type
Covered under Diagnostic and Preventive Dental (16b)
Restorative Services
Restorative Services benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
For periodicity, please see the notes.
Adjunctive General Services
Adjunctive General Services benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
occlusal guards-1 per 24 monthsocclusal adjustments-1 per yearhospital or ambulatory surgical center call-1 per 12 months
Endodontics
Endodontics benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
pulpotomy 1 per 6 monthspulpal debridement and root canals-1 per lifetime
Periodontics
Periodontics benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
For periodicity, please see the notes.
Prosthodontics, removable
Prosthodontics, removable benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
For periodicity, please see the notes.
Maxillofacial Prosthetics
Maxillofacial Prosthetics benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
Yes
Implant Services
Not covered.
Prosthodontics, fixed
Prosthodontics, fixed benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Fixed dentures and associated services- 1 per 60 monthsre-cement fixed partial dentures covered after 6 months of initial placement
Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery benefits are covered. Prior Authorization is required.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Alveoloplsty or Vertibuloplasty-1 per lifetimefacial bones-complicated reduction with fixation and multiple approaches-1 per 60 monthsOther services 1 per lifetime
Orthodontics
Not covered.
Home Infusion bundled Services
Home Infusion bundled Services benefits are covered. Prior Authorization is required.
More Details:
Does this plan have a service specific maximum enrollee out-of-pocket cost (MOOP)?
No
Does the plan offer step therapy?
Yes
Does the benefit step from?
Part B to Part D
Does the plan provide Part D home infusion drugs as part of a bundled service as a mandatory supplemental benefit?
No
Does the plan pay for Part D home infusion services and supplies as a Medicaid benefit?
No
Insulin
Insulin benefits are covered.
Medicare Part B Insulin Drugs
Medicare Part B Insulin Drugs benefits are covered.
Medicare Part B Chemotherapy/Radiation Drugs
Not covered.
Dialysis Services
Dialysis Services benefits are covered.
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a coinsurance?
No
Is there a copayment ?
No
Is there a copayment ?
No
Are there preferred vendors/manufacturers for Durable Medical Equipment (DME)?
Yes
Authorization required for this benefit?
Yes
Does this plan provide Non-Medicare-covered Durable Medical Equipment?
Yes
Non-Medicare-covered Durable Medical Equipment
Other 1
Is there a maximum plan benefit coverage amount?
No
Authorization required for this benefit?
Yes
Durable Medical Equipment for use outside the home
Not covered.
Prosthetics/Medical Supplies - Non-Medicare benefit
Prosthetics/Medical Supplies - Non-Medicare benefit benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a coinsurance?
No
Is there a copayment ?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Does this plan provide Non-Medicare-covered Prosthetics/Medical Supplies?
Yes
Enter name of Non-Medicare-covered Service
Non-Medicare Prosthetics/Medical Supplies
Is there a maximum plan benefit coverage amount?
No
Authorization required for this benefit?
Yes
Prosthetic Devices
Not covered.
Medical Supplies
Not covered.
Diabetic Equipment
Diabetic Equipment benefits are covered. Prior Authorization is required.
More Details:
Do you limit Diabetic supplies and services to those from specified manufacturers
Yes
Diabetic Supplies
Not covered.
Diabetic Therapeutic Shoes/Inserts
Not covered.
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
All Diagnostic services benefits are covered. Prior Authorization is required.
More Details:
Is there a copayment?
No
Diagnostic Procedures/Tests
Not covered.
Lab Services
Not covered.
All Radiological Services
All Radiological Services benefits are covered. Prior Authorization is required.
More Details:
Is there a copayment?
No
Diagnostic Radiological Services
Not covered.
Therapeutic Radiological Services
Not covered.
Outpatient X-Ray Services
Not covered.
Home Health Services
Home Health Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there an enrollee Coinsurance?
No
Is there a copayment ?
No
Is there an enrollee Copayment?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Is there a limit on the services provided?
No
Does this plan provide Non-Medicare-covered Home Health Services?
Yes
Non-Medicare-covered Home Health Services
Personal Care Services
Is there a maximum plan benefit coverage amount?
No
Does any service require qualification for and enrollment in a state-operated waiver program?
No
Authorization required for this benefit?
No
Referral required for this benefit?
No
Additional Hours of Care
Not covered.
Personal Care Services
Not covered.
Cardiac Rehabilitation Services
Cardiac Rehabilitation Services benefits are covered. Prior Authorization is required.
Cardiac Rehabilitation Services
Not covered.
Intensive Cardiac Rehabilitation Services
Not covered.
Pulmonary Rehabilitation Services
Not covered.
SET for PAD Services
Not covered.
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) benefits are covered. Prior Authorization is required.
More Details:
Does the plan provide Skilled Nursing Facility Services as a supplemental benefit under Part C?
Yes
Enhanced benefits (2)
Non-Medicare-covered stay (MMP Only)
Do you allow less than 3 day inpatient hospital stay prior to SNF admission?
Yes
Days
Zero
Periodicity
Original Medicare
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF) benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Non-Medicare-covered Stay for Skilled Nursing Facility (SNF)
Not covered.
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Over-the-Counter (OTC) Items benefits are covered.
More Details:
Does the plan provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C?
Yes
Is there a maximum plan benefit coverage amount?
Yes
Maximum plan benefit coverage amount
120.00
Periodicity
Every three months
Does your Maximum Plan Benefit Coverage amount carry forward to the next period if it is unused?
No
Plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit?
Yes
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Plan offers Naloxone coverage as a Part C OTC benefit?
Yes
Does this cover all of the drugs on the CMS OTC list which may be found in Chapter 4 of the Medicare Managed Care Manual
Yes
Meal Benefit
Meal Benefit benefits are covered. Prior Authorization is required.
More Details:
Does the plan provide a limited duration Meal Benefit as a supplemental benefit under Part C? Note: Only primarily health-related meals offered in accordance with Chapter 4 of the MMCM should be entered in this section.
Yes
Type of primarily health related meals benefit offered
Immediately following surgery or inpatient hospitilization, For a chronic illness, For a medical condition or potential medical condition that requires the enrollee to remain at home for a period of time
Is there a maximum plan benefit coverage amount?
No
Other 1
Other 1 benefits are covered.
More Details:
Service Name
Skid Proof Socks
Is there a maximum plan benefit coverage?
No
Other 2
Other 2 benefits are covered.
More Details:
Service Name
Personal Blanket
Is there a maximum plan benefit coverage amount?
No
Other 3
Other 3 benefits are covered.
More Details:
Service Name
Accessory Tote Bag
Is there a maximum plan benefit coverage amount?
No
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Other Services
Other Services benefits are covered.
More Details:
Does the plan provide Additional Services?
Yes
Additional Services
13h3: Freestanding Birth Center Services, 13h5: Family Planning Services, 13h6: Nursing Home Services, 13h7: Home and Community Based Services, 13h9: Self-Directed Personal Assistance Services, 13h12: Institution for Mental Disease Services for Individuals 65 or Older, 13h15: Other 1, 13h16: Other 2, 13h17: Other 3, 13h18: Other 4, 13h19: Other 5, 13h20: Other 6, 13h21: Other 7, 13h22: Other 8, 13h23: Other 9, 13h24: Other 10, 13h25: Other 11, 13h26: Other 12, 13h27: Other 13, 13h28: Other 14, 13h29: Other 15, 13h30: Other 16, 13h31: Other 17, 13h32: Other 18, 13h33: Other 19, 13h34: Other 20, 13h36: Other 22, 13h39: Other 25, 13h42: Other 28, 13h43: Other 29, 13h44: Other 30, 13h46: Other 32, 13h49: Other 35
Is there a limit on the Additional Services provided?
Yes
Additional Services where a limit applies
13h21: Other 7, 13h34: Other 20, 13h36: Other 22, 13h39: Other 25, 13h44: Other 30, 13h46: Other 32, 13h49: Other 35
Is there a maximum plan benefit coverage amount?
Yes
Additional Services have a Maximum Plan Benefit Coverage Amount
13h16: Other 2, 13h20: Other 6, 13h26: Other 12, 13h29: Other 15
Does any service require qualification for and enrollment in a state-operated waiver program?
Yes
Services that require qualification for and enrollment in a state-operated waiver program
13h15: Other 1, 13h16: Other 2, 13h17: Other 3, 13h18: Other 4, 13h19: Other 5, 13h20: Other 6, 13h21: Other 7, 13h23: Other 9, 13h24: Other 10, 13h25: Other 11, 13h26: Other 12, 13h27: Other 13, 13h29: Other 15, 13h30: Other 16, 13h31: Other 17, 13h32: Other 18, 13h33: Other 19
Is a beneficiary receiving any benefit subject to a state-required monthly payment amount that is based on his or her financial resources (for example: a "patient pay amount")?
No
Is Authorization required for one or more Additional Services?
Yes
Which Additional Services need an Authorization
13h6: Nursing Home Services, 13h7: Home and Community Based Services, 13h9: Self-Directed Personal Assistance Services, 13h12: Institution for Mental Disease Services for Individuals 65 or Older, 13h16: Other 2, 13h17: Other 3, 13h18: Other 4, 13h19: Other 5, 13h20: Other 6, 13h21: Other 7, 13h23: Other 9, 13h24: Other 10, 13h25: Other 11, 13h26: Other 12, 13h27: Other 13, 13h28: Other 14, 13h30: Other 16, 13h31: Other 17, 13h32: Other 18, 13h33: Other 19, 13h42: Other 28
Is a referral required for one or more Additional Services?
No
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
Not covered.
Private Duty Nursing Services
Not covered.
Case Management (Long Term Care)
Not covered.
Institution for Mental Disease Services for Individuals 65 or Older
Not covered.
Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities
Not covered.
Case Management
Not covered.
Other 1
Other 1 benefits are covered.
More Details:
Enter name of Other 1 Service
Nursing Services
Other 2
Other 2 benefits are covered.
More Details:
Enter name of Other 2 Service
Minor Home Modifications
Maximum plan benefit coverage amount
7500.00
Periodicity
Other, Describe
Description
Per lifetime.
Other 3
Other 3 benefits are covered.
More Details:
Enter name of Other 3 Service
Emergency Response Services
Other 4
Other 4 benefits are covered.
More Details:
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Assisted Living Services
Other 5
Other 5 benefits are covered.
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Adult Foster Care
Tobacco Cessation Counseling for Pregnant Women
Not covered.
Other 6
Other 6 benefits are covered.
More Details:
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Transitional Assistance Services
Maximum plan benefit coverage amount
2500.00
Periodicity
Other, Describe
Description
Per lifetime.
Other 7
Other 7 benefits are covered.
More Details:
Enter name of Other 7 Service
Respite Care
Units
Visits
Numerical limit
30
Periodicity
Every year
Other 8
Other 8 benefits are covered.
More Details:
Enter name of Other 8 Service
Behavioral Health Services
Other 9
Other 9 benefits are covered.
More Details:
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Employment Assistance
Other 10
Other 10 benefits are covered.
More Details:
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Supported Employment
Other 11
Other 11 benefits are covered.
More Details:
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Cognitive Rehabilitation Therapy
Other 12
Other 12 benefits are covered.
More Details:
Enter name of Other 12 Service
Adaptive Aids and Medical Supplies
Maximum plan benefit coverage amount
10000.00
Periodicity
Every year
Other 13
Other 13 benefits are covered.
More Details:
Enter name of Other 13 Service
Home-Delivered Meals
Other 14
Other 14 benefits are covered.
More Details:
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Personal Assistance Services
Other 15
Other 15 benefits are covered.
More Details:
Enter name of Other 15 Service
Dental Services
Maximum plan benefit coverage amount
5000.00
Periodicity
Every year
Freestanding Birth Center Services
Not covered.
Other 16
Other 16 benefits are covered.
More Details:
Enter name of Other 16 Service
Occupational Therapy
Other 17
Other 17 benefits are covered.
More Details:
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Speech, Hearing and Language Therapy
Other 18
Other 18 benefits are covered.
More Details:
Enter name of Other 18 Service
Support Consultation
Other 19
Other 19 benefits are covered.
More Details:
Enter name of Other 19 Service
Habilitation Services
Other 20
Other 20 benefits are covered.
More Details:
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Home Visits
Units
Hours
Numerical limit
8
Periodicity
Every year
Other 22
Other 22 benefits are covered.
More Details:
Enter name of Other 22 Service
Large Print Digital Clock
Units
Items/Other, Describe
Description
Other 22: One Large Print Digital Clock within 30 days of confirmed enrollment. Available one time only.
Numerical limit
1
Periodicity
Every Lifetime
Other 25
Other 25 benefits are covered.
More Details:
Enter name of Other 25 Service
Smoking and Tobacco Use Cessation Counseling
Units
Sessions
Numerical limit
8
Periodicity
Every Session/Visit
Respiratory Care Services
Not covered.
Other 28
Other 28 benefits are covered.
More Details:
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Nonemergency Medical Transportation (NEMT) Services
Other 29
Other 29 benefits are covered.
More Details:
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Cologuard
Other 30
Other 30 benefits are covered.
More Details:
Enter name of Other 30 Service
Cytogenomic Constitutional Microarray
Units
Items/Other, Describe
Description
Cytogenomic Constitutional Microarray
Numerical limit
1
Periodicity
Every Lifetime
Other 32
Other 32 benefits are covered.
More Details:
Enter name of Other 32 Service
Case Management for Children and Pregnant Women
Units
Sessions
Numerical limit
1
Periodicity
Every day
Other 35
Other 35 benefits are covered.
More Details:
Enter name of Other 35 Service
Emergency Triage, Treat, and Transport Benefits
Units
Items/Other, Describe
Description
Daily encounter.
Numerical limit
1
Periodicity
Every day
Family Planning Services
Not covered.
Nursing Home Services
Not covered.
Home and Community Based Services
Not covered.
Personal Care Services
Not covered.
Self-Directed Personal Assistance Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
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