Molina Dual Options (Medicare-Medicaid Plan) - 2022 (2024)

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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 BPart CPart DPart B Give BackTotal
$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 DLIS 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 TypeCost 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

Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.

Medicare has neither approved nor endorsed any information on this site.

This is a promotional communication.

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.

All plan-related information on this site is from CMS.gov and Medicare.gov.We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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 contactMedicare.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.

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Molina Dual Options (Medicare-Medicaid Plan) - 2022 (2024)
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