Medicare Counseling: Dual Eligible Special Need Plans (D-SNP) Plan – Molina Medicare Complete Care Select

Check what D-SNPs are available in your county and what Medicaid plans they accept. (Excel) After learning which plans you be able to get in your area, click on the plan names below to learn more about the plans.

Molina Medicare Complete Care Select (HMO D-SNP, H2879-005)

   For calendar year 2024

  Contact information

 Phone: 866-403-8293 (TTY: 711)

  Website: The Molina Healthcare website

  Eligibility

Who can get this plan

People with the following tiers of the Medicare Savings Programs:

• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualified Individual (known as SLMB+ in Wisconsin)
• Qualified Disabled Working Individual (QDWI)

Service area

Star rating

   
3 out of 5 stars

Coverage

 Check if your doctors are in-network: Molina provider online directory

  Check if your prescription drugs are covered: Molina pharmacy and drugs list; medicare.gov

  Costs

  Doctor visit: No cost

  Hospitalization: Same costs as Original Medicare

  Skilled nursing facility: Same costs as Original Medicare

Emergency department: $100 copay

Extra benefits

Details: Evidence of Coverage

  Basic dental:

• Preventive services: $0 copay for two oral exams, two cleanings, and two fluoride treatment annually
• X-Rays: periapicals (up to six annually) or bitewings (up to four annually) or panoramic (up to one every five years)

  Extra dental: $1,000 annual allowance

  Vision:

• Routine eye exam: one annually for no cost
• Eyewear: $500 annual allowance

  Hearing:

• Routine hearing exam: one exam annually for no cost
• Up to 2 hearing aids annually for no cost

Wellness programs: Fitness center membership and/or a home fitness kit (includes Fitness Activity Tracker option)

Other:

• Chiropractic: no cost for 12 visits annually
• Meals: no cost for up to 56 meals annually
• Over-the-counter (OTC): $410 quarterly allowance
• Personal Emergency Response System for no cost
• Transportation: no cost for 102 one-way trips annually
• Special Supplemental Benefits for the Chronically Ill (SSBCI)*:
  • Food and produce: $745 monthly
  • Service animal supplies, mental health & wellness applications, non-Medicare-covered genetic test kits: $150 combined quarterly allowance
  • Utilities: $150 quarter in member reimbursement, including electricity, natural gas, water, and internet

*Eligibility requirements apply

  How to enroll

You can only enroll during a Medicare enrollment period; learn more at Medicare.gov.

Enrollment into this plan will automatically disenroll you from your current Medicare Advantage or Part D plan.

There are multiple ways to enroll:

• Call the plan at 866-403-8293
• Medicare.gov
• 1-800-MEDICARE
• Contact the State Health Insurance Assistance Program (SHIP)