Molina Medicare Complete Care (HMO D-SNP)
Available to residents of Polk County, IA for 2027. Contract H4367, plan 001, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Renewed for 2027. CMS crosswalks 2026’s Molina Medicare Complete Care (HMO D-SNP) (H1799-004-0) into this plan, so its members move here unless they choose otherwise.
Plan details
| Monthly premium (Part C + D) | $0.50 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.50 |
| In-network out-of-pocket maximum | $9,850.00 |
| Drug deductible | $700.00Tier 1 and 6 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO D-SNP |
| Special needs plan | Dual-eligible SNP |
| D-SNP integration status | Highly Integrated (HIDE) |
| Zero-dollar cost sharing D-SNP | Yes |
| Contract / plan | H4367-001-0 |
| Offered by | Molina Healthcare of Iowa, Inc. |
| Parent organization | Molina Healthcare, Inc. |
| Formulary tiers | 6 |
| Member services | (844)246-7256TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H4367 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | 25% |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 25% |
| Tier 5 · Specialty Tier | 25% |
| Tier 6 · Select Care Drugs | $0.00 |
Also available in 2 other IA counties
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.