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Molina Medicare Complete Care (HMO D-SNP) - H8845-001-000
$0.00
Monthly Premium
Molina Medicare Complete Care (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Molina Healthcare, Inc.,
Plan ID: H8845-001-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
Arizona Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other additional benefits Original Medicare doesn’t cover.
Learn more about Arizona Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Enrollment may be limited to certain times of the year. See why you may be able to enroll today.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $615.00 |
| Out-of-pocket maximum | $9,250.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | Doctor Office Visit: |
| Specialty doctor visit | Doctor Specialty Visit: |
| Inpatient hospital care | Acute Hospital Services: |
| Urgent care | Urgent Care: |
| Emergency room visit | Emergency Care: |
| Ambulance transportation | Ground Ambulance: |
Health Care Services and Medical Supplies
Molina Medicare Complete Care (HMO D-SNP) covers a range of additional benefits. Learn more about Molina Medicare Complete Care (HMO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | Chiropractic Services:
|
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0 Prior authorization not required for preferred manufacturer. |
| Durable medical equipment (DME) | Durable Medical Equipment: |
| Diagnostic tests, lab and radiology services, and X-rays | Outpatient Diag Procs/Tests/Lab Services: |
| Home health care | Home Health Services: |
| Mental health inpatient care | Psychiatric Hospital Services: |
| Mental health outpatient care | Outpatient Mental Health Services: |
| Outpatient services/surgery | Outpatient Hospital Services: |
| Outpatient substance abuse care | Outpatient Substance Abuse Services: |
| Over-the-counter items | Over-The-Counter (OTC) Items: Unused allowance does not carry over to the next month. |
| Podiatry services | Podiatry Services: |
| Skilled Nursing Facility (SNF) care | Skilled Nursing Facility Services: |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | Medicare Covered Preventive Dental:
Copayment for Dental x-rays $0
Copayment for Prophylaxis $0
Copayment for Fluoride treatment $0
Copayment for Endodontics $0
Copayment for Periodontics $0
Copayment for Prothodontics, removable $0
Copayment for Maxillofacial surgery $0
Copayment for Adjunctive general services $0
Maximum Plan Benefit of $3,000 every year |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | Eye Exams:
|
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | Hearing Exams:
Copayment for Fitting/Evaluation for Hearing Aid $0
|
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | $0.00 copay for Medicare Covered Preventive Services:
Tobacco use cessation |
Prescription Drug Costs and Coverage
The Molina Medicare Complete Care (HMO D-SNP) offers prescription drug coverage, with an annual drug deductible of $615.00 (excludes Tiers 1 and 6)
Coverage & Cost | |
|---|---|
| Coverage | Cost |
| Annual drug deductible | $615.00 (excludes Tiers 1 and 6) |
| Tier 1 |
|
| Tier 6 |
|
| Annual drug deductible | $615.00 (excludes Tiers 1 and 6) |
| Tier 1 |
|
| Tier 6 |
|
| Annual drug deductible | $615.00 (excludes Tiers 1 and 6) |
| Tier 1 |
|
| Tier 6 |
|
When reviewing Arizona Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Arizona that offer similar benefits at similar or lower prices than the plan above. Call 1-855-861-8771 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Arizona Counties Served
We offer plans from Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Healthspring, Wellcare, or Kaiser Permanente.
Enrollment may be limited to certain times of the year. See why you may be able to enroll today.