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2016 Medicare Advantage Plan Benefit Details for the Molina Dual Options (Medicare-Medicaid Plan)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Advantage Plan Details
Medicare Plan Name:Molina Dual Options (Medicare-Medicaid Plan)
Location:McLean, Illinois     Click to see other locations
Plan ID:H8046 - 001 - 0     Click to see other plans
Member Services:1-877-901-8181 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Molina Dual Options (Medicare-Medicaid Plan) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:$0
Health Plan Type:MMP
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$0
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:3,208 drugsBrowse the Molina Dual Options (Medicare-Medicaid Plan) Formulary
This plan has 3 drug tiers. See cost-sharing for all pharmacies and tiers. 
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$0.00$0.00$0.00  
• Number of Drugs per
  Tier:		19271281
Plan's Pharmacy Search:http://www.molinamedicare.com
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in McLean, Illinois:443 members
Number of Members enrolled in this plan in Illinois:3,906 members
Number of Members enrolled in this plan in (H8046 - 001):4,037 members
Plan’s Summary Star Rating: New plan - No summary rating as of yet.
• Customer Service Rating: New plan - not yet rated.
• Member Experience Rating: New plan - not yet rated.
• Drug Cost Accuracy Rating: New plan - not yet rated.
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Monthly premium, deductible, and limits on how much you pay for covered services
Some services may require a monthly payment amount.
You pay nothing
In this plan you will pay nothing for services from any provider.
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
** Doctor and Hospital Choice **
Acupuncture
Not covered
** Extra Benefits **
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:  You pay nothing
Other Part B drugs1:  You pay nothing
You may get your drugs at network retail pharmacies and mail order pharmacies.
You pay nothing
If you reside in a long-term care facility you pay the same as at a retail pharmacy.
You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
You pay nothing
Institutional care
Institution for mental disease services for individuals 65 or older:   You pay nothing
Nursing home services:   You pay nothing
** Important Information **
Monthly premium, deductible, and limits on how much you pay for covered services
Some services may require a monthly payment amount.
You pay nothing
In this plan you will pay nothing for services from any provider.
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
** Outpatient Care and Services **
Acupuncture
Not covered
Additional home care services
Home and community based services:   You pay nothing
Additional services
Hospice:   You pay nothing
Behavioral Health:   You pay nothing
Telehealth:   You pay nothing
Emergency Dental:   You pay nothing
Ambulance
You pay nothing
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  You pay nothing
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  You pay nothing
Preventive dental services:
  • Cleaning (for up to 2 every year):  You pay nothing
  • Dental x-ray(s) (for up to 1 every year):  You pay nothing
  • Fluoride treatment (for up to 1 every year):  You pay nothing
  • Oral exam (for up to 2 every year):  You pay nothing
    • Our plan pays up to $600 every year for preventive dental services.
    Diabetes supplies and services
    Diabetes monitoring supplies:  You pay nothing
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  You pay nothing
    Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs CT scans):  You pay nothing
    Diagnostic tests and procedures:  You pay nothing
    Lab services:  You pay nothing
    Outpatient x-rays:  You pay nothing
    Therapeutic radiology services (such as radiation treatment for cancer):  You pay nothing
    Doctor's office visits
    Primary care physician visit:  You pay nothing
    Specialist visit:  You pay nothing
    Durable medical equipment (wheelchairs, oxygen, etc.)
    You pay nothing
    Durable medical equipment for use outside the home:  You pay nothing
    Emergency care
    You pay nothing
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam (for up to 1 every year):  You pay nothing
    Hearing aid fitting/evaluation (for up to 1 every three years):  You pay nothing
    Hearing aid:  You pay nothing
    Home health care
    You pay nothing
    Additional hours of care:  You pay nothing
    Mental health care
    Inpatient visit:
    Our plan covers an unlimited number of days for an inpatient hospital stay.
    You pay nothing
    Outpatient group therapy visit:  You pay nothing
    Outpatient individual therapy visit:  You pay nothing
    Outpatient rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):  You pay nothing
    Occupational therapy visit:  You pay nothing
    Non-Medicare Occupational Therapy Services:  You pay nothing
    Physical therapy and speech and language therapy visit:  You pay nothing
    Non-Medicare Physical Therapy Services:  You pay nothing
    Non-Medicare Speech Therapy Services:  You pay nothing
    Outpatient substance abuse
    Group therapy visit:  You pay nothing
    Individual therapy visit:  You pay nothing
    Outpatient surgery
    Ambulatory surgical center:  You pay nothing
    Outpatient hospital:  You pay nothing
    Over-the-counter items
    Please visit our website to see our list of covered over-the-counter items.
    Prosthetic devices (braces, artificial limbs, etc.)
    Prosthetic devices:  You pay nothing
    Related medical supplies:  You pay nothing
    Non-Medicare Prosthetics/Medical Supplies:  You pay nothing
    Renal dialysis
    You pay nothing
    Transportation
      You pay nothing
    Urgently needed services
    You pay nothing
    Vision services
    Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  You pay nothing
    Routine eye exam (for up to 1 every year):  You pay nothing
    Contact lenses:  You pay nothing
    Eyeglasses (frames and lenses) (for up to 1 every two years):  You pay nothing
    Eyeglass frames:  You pay nothing
    Eyeglasses or contact lenses after cataract surgery:  You pay nothing
    ** Hospice **
    Hospice
    You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
    ** Preventive Care **
    Preventive care
    You pay nothing
    Our plan covers many preventive services including:
    • Abdominal aortic aneurysm screening
    • Alcohol misuse counseling
    • Bone mass measurement
    • Breast cancer screening (mammogram)
    • Cardiovascular disease (behavioral therapy)
    • Cardiovascular screenings
    • Cervical and vaginal cancer screening
    • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
    • Depression screening
    • Diabetes screenings
    • HIV screening
    • Medical nutrition therapy services
    • Obesity screening and counseling
    • Prostate cancer screenings (PSA)
    • Sexually transmitted infections screening and counseling
    • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
    • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
    • "Welcome to Medicare" preventive visit (one-time)
    • Yearly "Wellness" visit
    Any additional preventive services approved by Medicare during the contract year will be covered.
    Family planning services:  You pay nothing
    Tobacco cessation counseling for pregnant women (for up to 12 sessions every year):  You pay nothing.
    ** Inpatient Care **
    Inpatient hospital care
    Our plan covers an unlimited number of days for an inpatient hospital stay.
    You pay nothing
    Inpatient mental health care
    For inpatient mental health care see the "Mental Health Care" section.
    Institutional care
    Institution for mental disease services for individuals 65 or older:   You pay nothing
    Nursing home services:   You pay nothing
    Skilled Nursing Facility (SNF)
    Our plan covers an unlimited number of days in a SNF.
    You pay nothing
    Outpatient prescription drugs
    For Part B drugs such as chemotherapy drugs1:  You pay nothing
    Other Part B drugs1:  You pay nothing
    You may get your drugs at network retail pharmacies and mail order pharmacies.
    You pay nothing
    If you reside in a long-term care facility you pay the same as at a retail pharmacy.
    You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
    You pay nothing
    Additional home care services
    Home and community based services:   You pay nothing
    ** Outpatient Care **
    Diabetes supplies and services
    Diabetes monitoring supplies:  You pay nothing
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  You pay nothing
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam (for up to 1 every year):  You pay nothing
    Hearing aid fitting/evaluation (for up to 1 every three years):  You pay nothing
    Hearing aid:  You pay nothing
    ** Outpatient Medical Services and Supplies **
    Outpatient substance abuse
    Group therapy visit:  You pay nothing
    Individual therapy visit:  You pay nothing
    Prosthetic devices (braces, artificial limbs, etc.)
    Prosthetic devices:  You pay nothing
    Related medical supplies:  You pay nothing
    Non-Medicare Prosthetics/Medical Supplies:  You pay nothing
    ** Additional Benefits **
    Inpatient mental health care
    For inpatient mental health care see the "Mental Health Care" section.
    Institutional care
    Institution for mental disease services for individuals 65 or older:   You pay nothing
    Nursing home services:   You pay nothing




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