Molina Healthcare offers both Medicaid and Medicare plans, depending on which program you enroll in
Molina Healthcare is an insurance company that contracts with both Medicaid and Medicare to serve people in those programs. The type of coverage you get from Molina depends on which program you join — not on Molina itself. If you enroll in your state's Medicaid program, Molina may be one of the managed care plans available to you. If you enroll in Medicare, Molina may offer Medicare Advantage plans in your area. You cannot get Molina coverage through both programs at the same time, though some people do transition from one to the other as their circumstances change.
Key Takeaways
- Molina Healthcare operates as a managed care plan under both Medicaid and Medicare, so the program you choose determines which Molina plan you receive.
- Molina Medicaid plans are state-specific and cover low-income adults, children, pregnant people, and seniors depending on your state's rules.
- Molina Medicare plans are Medicare Advantage plans available to people age 65 and older or those with certain disabilities, and they include prescription drug coverage.
- You can compare Molina plans available in your area by checking your state Medicaid website or Medicare.gov, depending on which program you are considering.
How Molina works as a Medicaid plan
When Molina operates as a Medicaid plan, it is a managed care organization — meaning it contracts with your state to deliver Medicaid benefits to members. Your state Medicaid program pays Molina a fixed amount per member each month, and Molina then coordinates your care, manages your doctor visits, and handles claims. You do not pay Molina directly; Medicaid does.
Molina Medicaid plans vary by state because each state runs its own Medicaid program with different rules, covered services, and participating doctors. In some states, Molina is one of several managed care options you can choose from. In others, Molina may be the only option, or it may not be available at all. To learn about Molina offers a Medicaid plan in your state, visit your state Medicaid website or call your state Medicaid office.
Molina Medicaid coverage typically includes doctor visits, hospital care, prescription drugs, and preventive services. Some state plans also cover dental, vision, or mental health services through Molina. The exact benefits depend on your state and which Medicaid category you fall into — such as low-income adults, children, pregnant people, or seniors.
How Molina works as a Medicare plan
When Molina operates as a Medicare plan, it offers Medicare Advantage plans (also called Part C plans). These are private insurance plans that contract with Medicare to provide Part A (hospital) and Part B (medical) coverage, plus usually Part D (prescription drug) coverage. You must be enrolled in Medicare to join a Molina Medicare Advantage plan.
Molina Medicare Advantage plans are available in certain geographic areas and change year to year. If you are age 65 or older, or if you have been on Social Security Disability Insurance (SSDI) for at least two years, you can enroll in a Molina Medicare Advantage plan during the annual enrollment period (October 15 to December 7 each year). You pay a monthly premium to Molina, and Medicare reimburses Molina for your care.
Medicare Advantage plans through Molina typically include doctor visits, hospital stays, prescription drugs, and preventive care. Many also offer dental, vision, or hearing coverage as an added benefit. However, you usually pay a copay when you use services, and you must use doctors and hospitals in Molina's network.
The main differences between Molina Medicaid and Molina Medicare plans
| Feature | Molina Medicaid | Molina Medicare Advantage |
|---|---|---|
| Who it is for | Low-income individuals and families; rules vary by state | People age 65+, or those on SSDI for 2+ years |
| Who pays Molina | Your state Medicaid program | Medicare (federal government) |
| What you pay | Usually $0 to $5 per visit; varies by state | Monthly premium plus copays for services |
| Availability | Varies by state; not available everywhere | Available in certain geographic areas; changes yearly |
| Enrollment period | Year-round in most states | October 15 to December 7 each year |
How to learn about Molina is available in your area
To check if Molina offers a Medicaid plan where you live, go to your state Medicaid website and look for the list of managed care plans. You can also call your state Medicaid office directly. They will tell you which plans are available, what they cover, and how to enroll. Most states allow you to switch plans once a year or during certain life changes.
To check if Molina offers a Medicare Advantage plan in your area, visit Medicare.gov and use the plan finder tool. Enter your zip code and the tool will show you all available plans, including Molina options. You can compare premiums, copays, covered drugs, and in-network doctors before you enroll. Open enrollment for Medicare runs from October 15 to December 7 each year.
What happens if you move or your income changes
If you have a Molina Medicaid plan and your income increases, you may no longer be may be able to access for Medicaid in your state. Your coverage will end, and you will need to find other insurance — such as a job-based plan or a marketplace plan. If your income decreases, you may become may be able to access for Medicaid again and can enroll in a Molina plan if it is available.
If you move to a different state, your Molina Medicaid plan will not follow you. You will need to enroll in your new state's Medicaid program and choose from the managed care plans available there. Molina may or may not operate in your new state. If you have a Molina Medicare Advantage plan and move, you may be able to keep it if Molina serves your new area, or you may need to switch to a different plan.
Frequently Asked Questions
Can I have both a Molina Medicaid plan and a Molina Medicare plan at the same time?
No. You can only be enrolled in one or the other. However, if you turn 65 while on Medicaid, you will transition to Medicare, and your Medicaid coverage will end. At that point, you can enroll in a Molina Medicare Advantage plan if one is available in your area.
Does Molina Healthcare own Medicaid or Medicare?
No. Molina Healthcare is a private insurance company that contracts with state Medicaid programs and with Medicare to deliver benefits. Medicaid is run by states and the federal government. Medicare is run by the federal government. Molina is hired to manage care and process claims for people in those programs.
How do I know which Molina plan I have?
Check your insurance card or the welcome packet Molina sent you when you enrolled. It will say either "Medicaid" or "Medicare Advantage" on the materials. You can also call Molina's customer service number on your card and ask them which program you are enrolled in.
What if Molina is not available in my state or area?
If Molina does not offer a plan where you live, you will need to choose from the other managed care plans available through your state Medicaid program or through Medicare.gov. Your state Medicaid website or Medicare.gov will show you all available options in your area.