Molina Medicare Options (HMO) is a Medicare Advantage Prescription Drug plan for people with Medicare. The plan offers all the benefits of Original Medicare and much more. You are eligible for Molina Medicare Options (HMO) if you:
- Are entitled to Medicare Part A, and;
- Are enrolled in Medicare Part B and continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party
- Reside in the Molina service area
To find out more about Molina Medicare Options (HMO) plan benefits, please click on the Plan Materials in the left hand column. They include:
- Enrollment form - Please complete this form to enroll in the plan. If you need help in completing the form, please contact Molina Medicare at
1-866-403-8293 (TDD/TTY: 1-800-346-4128) from 8 a.m. to 8 p.m. Monday – Sunday. You may only enroll in Molina Medicare Options (HMO) at certain times of the year.*
- Evidence of Coverage (EOC) - The EOC explains your rights, benefits, and responsibilities as a member of Molina Medicare. It also explains our responsibilities to you.
- Summary of Benefits/Provider Directories - The Summary of Benefits outlines your plan premium, benefits, copayments and coinsurance for the current calendar year. The Provider Directories outlines your plan's network of Primary Care Physicians, Specialists, Hospitals, Skilled Nursing Facilities, Outpatient Facilities, and Supplemental Benefits.
- Low Income Subsidy (LIS) Chart - This table shows you what your monthly plan premium will be if you get extra help from Medicare in paying certain prescription drug costs.
- Forms - The following forms may be helpful and are available through this link: Appointment of Representative Form (CMS-1696), Coverage Determination Request Form, Drug Determination Request Form, How to Request a Re-Determination?, and Pharmacy Direct Member Reimbursement Form.
- HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers.
- Notice of Privacy Practice - This notice describes how medical information about you may be used and disclosed. It also explains how you can get access to this information.
- Contact HIPAA - This link provides information on how to contact the HIPAA office in your state.
This information is available for free in other languages. Please contact our customer service number at 1-800-665-3086 TTY 711 Monday - Sunday, 8:00 am to 8:00 pm local time, for additional information.
Esta información está disponible gratuitamente en otros idiomas. Para información adicional, favor de llamar a nuestro departamento de Servicios para Miembros de lunes a domingo de las 8:00 a.m. a las 8:00 p.m. tiempo local al: 1-800-665-3086 o al TTY al: 711.
Printed copies of information posted on our web site are available upon request.
*You may enroll in this plan during the Annual Enrollment Period from October 15th through December 7th of any year.