Molina Medicare Plans

When it comes to Molina Medicare plans, you need clear facts. Our guide provides an upfront look at the different Medicare Advantage plans Molina offers in 2025, real cost details including the $0 premium option, and where these plans are available.

Understanding the ins and outs of plan variety, costs, and coverage can be straightforward, and this article aims to deliver exactly that.


Key Takeaways


  • Molina Medicare Advantage Plans typically have a $0 monthly premium and may offer giveback benefits to reimburse a portion of Medicare Part B premiums, although other costs like copays, coinsurance, deductibles, and out-of-pocket maximums vary by plan.


  • Molina’s Medicare Advantage plans have lower than average CMS Star Ratings (2.78 out of 5) and NCQA scores (ranging from 2.0 to 3.0), reflecting areas needing improvement such as customer satisfaction and plan performance.

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Understanding Molina Medicare Advantage Plans


Molina Medicare Plans, Understanding Molina Medicare Advantage Plans


Many are drawn to Molina for its variety of Medicare Advantage plans, offering tailored healthcare coverage to seniors. The plans encompass an array of options, including HMO plans, thereby catering to a multitude of healthcare needs.

The regional availability of Molina Medicare Advantage Plans spans across 14 states, making it a significant player in the healthcare industry, while some areas might still be considered a blocked region.


Plan Variety

Molina Healthcare, renowned for its personalized approach towards comprehensive healthcare coverage, offers a variety of Medicare Advantage plans.

These plans, such as the Molina Medicare Complete Care (HMO D-SNP), Molina Medicare Choice Care (HMO), and a selection of state-specific Medicare Advantage plans, are tailored to meet the diverse healthcare needs of seniors.

The unique characteristics of Molina’s plans, such as the inclusion of preventive dental services and specialized programs for conditions like COPD and asthma, set them apart in the healthcare market.


Regional Availability

Regional availability is a key factor for many when choosing a healthcare plan. With Molina, those residing in 14 states, including California, Michigan, and Texas, have access to their Medicare Advantage prescription drug plans.

As the seventh-largest for-profit Medicare Advantage provider, Molina continues to expand its geographical reach, promising quality healthcare for many.


The Cost Breakdown of Molina Medicare Plans


Molina Medicare Plans, The Cost Breakdown of Molina Medicare Plans


Potential enrollees need to grasp the cost breakdown of Molina Medicare Plans. Molina Medicare Advantage Plans generally offer a monthly premium of $0, with some plans even offering reductions in Part B premiums for their members.

Alongside premiums, other supplementary expenses such as copays, coinsurance, deductibles, and out-of-pocket maximums may apply, depending on the chosen plan and individual health requirements.


Premiums and Part B Contributions

A significant advantage of Molina’s Medicare Advantage Plans is their $0 premium. These plans do not require individuals and families to pay a monthly premium, although enrollees are responsible for covering all costs up to the deductible amount before the plan begins to cover expenses.

Furthermore, some of these plans offer giveback benefits, reimbursing members for a portion of their Medicare Part B premiums, while also providing coverage for prescription medications under Part D, thereby enhancing affordability.


Additional Costs

Despite the affordability of Molina’s $0 premium plans, other potential costs should not be overlooked. For instance, the variability of copays, coinsurance, and deductibles is influenced by factors like the chosen plan, the location of the beneficiary, and their individual health needs.

The specific deductibles for Molina Medicare plans, for instance, vary based on the plan an individual is enrolled in, necessitating a thorough review of plan documents or direct communication with Molina Healthcare.

Prescription Drug Coverage with Molina


Molina Medicare Plans, Prescription Drug Coverage with Molina


Prescription drug coverage, a vital component of any healthcare plan, is adequately covered by Molina Medicare Advantage Plans. All of Molina’s plans encompass some degree of prescription drug coverage, although the specifics may vary depending on the formulary and guidelines of each individual plan.

To secure coverage for prescription drugs, ensure the drug is listed on Molina’s formulary and is medically necessary.

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Evaluating Molina’s Medicare Plan Ratings

Molina Medicare Plans, Evaluating Molina's Medicare Plan Ratings

Despite Molina’s numerous benefits, their Medicare Plan ratings should be considered before making a decision. The star rating of Molina’s Medicare Advantage plan is lower than the average rating of the overall provider, indicating a need for improvement in certain areas.

Factors contributing to these low ratings include complaints about the plan and members choosing to leave the plan.


CMS Star Ratings

The CMS Star Ratings system, established by the Centers for Medicare & Medicaid Services, provides a useful tool for comparing the quality of Medicare health and drug plans. Molina’s average CMS Star Rating for 2024 is 2.78, which is significantly below the national provider average of 4.04 stars.

This rating is determined through an evaluation system that assesses the quality of care and performance measures associated with the care quality delivered by facilities.


NCQA Scores

The National Committee for Quality Assurance (NCQA) is another important measure of a healthcare plan’s quality. Molina’s Medicare Advantage plans have NCQA scores ranging from 2.0 to 3.0 stars out of 5, with the majority rated at 2.5 stars.

The NCQA assesses and rates health plans based on actual measurements of clinical performance and consumer experience, highlighting areas where Molina could improve.

How to Choose the Right Molina Medicare Plan

Selecting the correct Molina Medicare Plan requires weighing a range of factors, including:

  • Costs


  • Network availability


  • Prescription drug coverage


  • Other plan benefits


To ensure that your healthcare provider is part of Molina’s network, you can contact Member Services at (855) 687-7861 for a printed copy of the provider directory.


Network Considerations

When dealing with Molina, awareness of network considerations is necessary. A network provider in Molina Medicare Advantage Plans refers to a healthcare provider that has a contractual agreement with Molina Healthcare to deliver services to plan members.

Moreover, Molina Medicare mandates that referrals from the primary care provider (PCP) are required to see a network specialist, although there are exceptions for certain services that do not necessitate a referral or a request from a computer.


Comparing Benefits

Comparing benefits is a crucial step in selecting a Molina Medicare Plan. Molina’s prescription drug coverage is comprehensive, with all plans including some degree of prescription drug coverage.

In addition to medical and drug coverage, Molina offers a variety of supplementary benefits, such as:

  • Oral exams


  • Prophylaxis


  • Fluoride treatment


  • Dental X-rays


  • Additional perks for Molina Dual Options members

Molina Healthcare: Company Profile


Molina Medicare Plans, Molina Healthcare: Company Profile


Gaining insight into the company behind the plans can be beneficial. Molina Healthcare:

  • Provides health insurance for low-income individuals and families


  • Provides coverage through Medicare, Medicaid, and state health insurance marketplace plans


  • Headquartered in Long Beach, California


  • Prioritizes preventive care, care coordination, and community-based services to enhance health outcomes for its members.


Company Origins

Molina Healthcare, also known as California Molina Healthcare, has a rich history, originally established by Dr. C. David Molina, an emergency room physician in Long Beach, California. He practices medicine in a fast-paced environment, providing critical care to patients in need.

Dr. Molina founded the healthcare company to create medical clinics that would provide healthcare services to the lowest-income patients, irrespective of their financial capability.

Since its establishment, Molina Healthcare has expanded its reach through Medicaid expansion, integrated Medicare-Medicaid Plans (MMP), and the acquisition of other healthcare companies.


Financial Health

Financial stability is a key indicator of a company’s potential for continued growth in the Medicare Advantage market.

For the fiscal year 2022, Molina Healthcare recorded total revenue of $32 billion and reported premium revenue of $30.9 billion. Additionally, the company disclosed GAAP earnings of $13.55 per diluted share for the full year.

Over the past five years, Molina Healthcare has observed a 7.83% increase in revenue, indicating a positive trajectory.

Navigating Challenges: Limitations and User Concerns

Despite the plethora of benefits offered by Molina Healthcare, potential challenges and limitations should not be overlooked.

Low star ratings in Molina Medicare plans can be attributed to factors such as their average overall CMS star rating of 2.78 and adverse effects from customer reviews.

Additionally, there have been documented instances of access issues with Molina Medicare plans, such as a denial rate of 19.5 percent for automated request prior authorization in 2019.


Understanding Low Star Ratings

Various factors, such as customer service and the quality of plan benefits, can contribute to low star ratings. For instance, some factors that may contribute to low star ratings include:

  • Poor customer service


  • Limited network of providers


  • High out-of-pocket costs


  • Limited coverage for prescription drugs


  • Lack of additional benefits, such as dental or vision coverage


In the case of Molina’s Medicare Advantage plans, their below-average star ratings may reflect on the performance and quality of their benefits.


Overcoming Access Issues

Overcoming access issues may involve exploring alternative providers or considering Molina’s other healthcare offerings, such as Medicaid or marketplace plans.

If you encounter any challenges with accessing Molina Medicare plans, we apologize for the inconvenience and encourage you to appeal decisions that deny or reduce services, as well as to submit a complaint or grievance related to issues with your medical care or services.


In summary, Molina Medicare Advantage Plans offer a wide range of options and comprehensive coverage, making it an attractive choice for many. However, it’s important to consider factors such as the plan’s cost breakdown, regional availability, prescription drug coverage, and ratings before deciding.

With careful consideration and thorough research, choosing a suitable Molina Medicare Plan can be a seamless process.


Frequently Asked Questions


→  Is Molina Medical or Medicare?

Molina Healthcare offers Medicare Advantage plans designed for individuals with Medicare or both Medicare and Medicaid coverage. This makes Molina a Medicare provider.


→  Is Molina Healthcare of Washington Medicare?

Yes, Molina Medicare Complete Care is a Medicare Advantage plan for individuals with both Medicare and Medicaid, offering benefits beyond Original Medicare.


  Is Molina Medicaid?

Yes, Molina serves members through Medicaid, Medicare, and Health Insurance Exchange programs.


→  How much do Molina Medicare Advantage Plans cost?

Molina Medicare Advantage Plans typically offer a monthly premium of $0, but other costs like copays, coinsurance, deductibles, and out-of-pocket maximums may apply. Be sure to consider all potential expenses.


 Does Molina offer prescription drug coverage?

Yes, all Molina Medicare Advantage Plans offer prescription drug coverage.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.