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H8677 - 001 - 0
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Molina Dual Options (Medicare-Medicaid Plan)is a Medicare Advantage Plan by .
This page features plan details for 2022 Molina Dual Options (Medicare-Medicaid Plan)H8677 – 001 – 0 available in Counties: San Diego, parts of Riv. & S. Bernardino.
IMPORTANT: This page features the 2022 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
Molina Dual Options (Medicare-Medicaid Plan)is offered in the following locations.
California
Riverside County, California
San Bernardino County, California
Click to see more locations
Plan Overview
Molina Dual Options (Medicare-Medicaid Plan)offers the following coverage and cost-sharing.
Insurer: | |
Health Plan Deductible: | $0 |
MOOP: | Not Applicable |
Drugs Covered: | Yes |
Please Note:
- This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.
Ready to sign up for Molina Dual Options (Medicare-Medicaid Plan)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
Molina Dual Options (Medicare-Medicaid Plan)has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium.The following is a breakdown of your monthly premium with Part B costs included.
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$170.10 | $0.00 | $0.00 | $0.00 | $0.00 |
Please Note:
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Molina Dual Options (Medicare-Medicaid Plan)provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $ |
Catastrophic Coverage Limit: | $7,050.00 |
Drug Benefit Type: | |
Gap Coverage: | |
Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$0.00 | $0.00 | $0.00 | $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 $. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
30 Day
90 Day
30 Day
90 Day
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Drug Type | Cost Share |
---|---|
Generic drugs | $0 copay |
Brand-name drugs | $0 copay |
Additional Benefits
Molina Dual Options (Medicare-Medicaid Plan)also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
In-Network: No |
Dental (comprehensive)
Diagnostic services: | Not covered |
Endodontics: | Not covered |
Extractions: | Not covered |
Non-routine services: | Not covered |
Periodontics: | Not covered |
Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered |
Restorative services: | Not covered |
Dental (preventive)
Cleaning: | Not covered |
Dental x-ray(s): | Not covered |
Fluoride treatment: | Not covered |
Oral exam: | Not covered |
Diagnostic procedures/lab services/imaging
Diagnostic radiology services (e.g., MRI): | $0 copay (authorization required) |
Diagnostic tests and procedures: | $0 copay (authorization required) |
Lab services: | $0 copay (authorization required) |
Outpatient x-rays: | $0 copay (authorization required) |
Doctor visits
Primary: | $0 copay |
Specialist: | $0 copay |
Emergency care/Urgent care
Emergency: | $0 copay |
Urgent care: | $0 copay |
Foot care (podiatry services)
Foot exams and treatment: | $0 copay (authorization required) |
Routine foot care: | Not covered |
Ground ambulance
$0 copay |
Health plan deductible
$0.00 |
Health plan deductibles (other)
In-Network: No |
Hearing
Fitting/evaluation: | $0 copay (limits may apply) |
Hearing aids: | $0 copay (limits may apply) (authorization required) |
Hearing exam: | $0 copay |
Hospital coverage (inpatient)
$0 copay (authorization required) |
Hospital coverage (outpatient)
$0 copay (authorization required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Not Applicable |
Medical equipment/supplies
Diabetes supplies: | $0 copay (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 copay (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | $0 copay (authorization required) |
Medicare Part B drugs
Chemotherapy: | $0 copay (authorization required) |
Other Part B drugs: | $0 copay (authorization required) |
Mental health services
Inpatient hospital – psychiatric: | $0 copay (authorization required) |
Outpatient group therapy visit with a psychiatrist: | $0 copay (authorization required) |
Outpatient group therapy visit: | $0 copay (authorization required) |
Outpatient individual therapy visit with a psychiatrist: | $0 copay (authorization required) |
Outpatient individual therapy visit: | $0 copay (authorization required) |
Optional supplemental benefits
No |
Preventive care
$0 copay |
Rehabilitation services
Occupational therapy visit: | $0 copay (authorization required) |
Physical therapy and speech and language therapy visit: | $0 copay (authorization required) |
Skilled Nursing Facility
$0 copay (authorization required) |
Transportation
$0 copay |
Vision
Contact lenses: | $0 copay (limits may apply) |
Eyeglass frames: | Not covered |
Eyeglass lenses: | Not covered |
Eyeglasses (frames and lenses): | $0 copay (limits may apply) |
Other: | Not covered |
Routine eye exam: | $0 copay (limits may apply) |
Upgrades: | Not covered |
Wellness programs (e.g., fitness, nursing hotline)
Covered (authorization required) |
Ready to sign up for Molina Dual Options (Medicare-Medicaid Plan)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Table of Contents
Get Help Enrolling
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
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
SMID: MULTIPLAN_HCIHNDOGMED01_M
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