Molina Medicare Choice Care (HMO)

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Molina Medicare Choice Care (HMO) is a HMO plan offered by Molina Healthcare, Inc.,

Plan ID: H2715-003

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as Molina Medicare Choice Care (HMO) - H2715-003 by Molina Healthcare, Inc., as well as other Medicare Advantage plans available in your area.

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Illinois Counties Served

AdamsBondBooneBrownBureauCalhounCarrollCassClintonCookDewittDouglasDupageFayetteFordGreeneHancockIroquoisKaneKendallLeeLivingstonLoganMacoupinMadisonMarshallMcdonoughMcleanMenardMonroeMontgomeryMoultrieOglePiattPikePutnamSaint ClairSchuylerScottShelbyStarkStephensonWashingtonWillWinnebagoWoodford

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $9250
Out-of-Network: N/A
Initial Coverage Limit $2100
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty Doctor Visit


Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $40
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$295 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Acute Hospital Services
Urgent Care

Urgent Care:
Copayment for Urgent Care $40

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0
Maximum Plan Benefit of $10,000
Emergency Room Visit

Emergency Care:
Copayment for Emergency Care $115
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0
Copayment for Worldwide Emergency Transportation $0
Maximum Plan Benefit of $10,000
Ambulance Transportation


Ground Ambulance:
Coinsurance for Ground Ambulance Services $20%

Prior authorization required for non-emergent ambulance only.

Air Ambulance:
Coinsurance for Air Ambulance Services $20%
Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

Molina Medicare Choice Care (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services


Chiropractic Services:
Coinsurance for Medicare-covered Chiropractic Services 20%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring


Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0

Prior authorization may be required. Prior authorization required for diabetic shoes and inserts. Prior authorization is not required for preferred manufacturer.
Durable Medical Equipment (DME)

Durable Medical Equipment:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior authorization may be required. Prior authorization is not required for preferred manufacturers.
Diagnostic Tests, Lab and Radiology Services, and X-Rays


Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare-covered Diagnostic Procedures/Tests 0% to 20%
Copayment for Medicare-covered Lab Services $0
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
Minimum coinsurance applies to diagnostic procedures and tests received at a freestanding location. Maximum coinsurance applies to diagnostic procedures and tests received at a hospital.

Outpatient Diag/Therapeutic Rad Services:
Coinsurance for Medicare-covered Diagnostic Radiological Services 20%
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $0

Prior authorization may be required for some services. No authorization is required for outpatient lab services and outpatient x-ray services. Genetic lab testing requires prior authorization.
Home Health Care


Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Mental Health Inpatient Care


Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0
Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care


Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $45
Copayment for Medicare-covered Group Sessions $45

Prior authorization may be required.
Outpatient Services / Surgery


Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $500
Prior Authorization Required for Outpatient Hospital Services
Minimum amount for diagnostic colonoscopies in an outpatient setting. Maximum amount for all other services.

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $295
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0 to $250
Prior Authorization Required for Ambulatory Surgical Center Services
Minimum amount for diagnostic colonoscopies in an ASC setting. Maximum amount for all other services.

Intensive Outpatient Program Services: $70.00 copay Prior Authorization Required
Outpatient Substance Abuse Care


Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $40
Copayment for Medicare-covered Group Sessions $40
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter (OTC) Items
Podiatry Services


Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $0
Prior Authorization Required for Podiatry Services
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$145 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care


Medicare Covered Preventive Dental:
Copayment for Office Visit $40

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits


Eye Exams:
Copayment for Medicare Covered Benefits $40

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits

Hearing Exams:
Copayment for Medicare Covered Benefits $10

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs


$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:

  • COVID-19 shots

  • Flu shots

  • Hepatitis B shots

  • Pneumococcal shots

Tobacco use cessation
Yearly "Wellness" visit
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