Senior's Review of Molina Healthcare in Florida

Molina Healthcare is a Fortune 500, multi-state healthcare organization that provides health services and health information management solutions to almost five million people who receive care through Medicare, Medicaid and other government-funded programs in 15 states, including Florida.

The stated mission of Molina Healthcare in Florida is simple…to provide quality healthcare to people receiving government assistance.

Molina provides National Committee for Quality Assurance (NCQA) accredited care and services that promote health, wellness and improved patient outcomes.  Currently, nine of Molina’s 12 health plans are accredited (including Florida), and Molina’s intends for all its health plans to be NCQA accredited.

Molina’s 24-hour Nurse Advice Line is also accredited by the Utilization Review Accreditation Commission (URAC), which is an independent organization that promotes quality healthcare through accreditation, education and measurement programs.

It uses Healthcare Effectiveness Data and Information Set (maintained by the NCQA) as a way to also measure its quality of care.  Molina’s goal is to be better than 75% of other Medicaid health plans across the nation.

Molina has a strong commitment to giving back in the communities it serves.  The Molina Helping Hands program provides volunteer opportunities for employees.  In addition, the Molina Community Champions Awards recognize the vibrant contributions of community heroes across the country.  As part of a strong corporate social responsibility initiative, Molina is also constantly identifying and making donations to grassroots organizations in the communities it serves.

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HeadquartersFlorida Headquarters: 8300 NW 33rd St #400, Miami, FL 33122
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What types of services does Molina healthcare in Florida provide?

Molina Healthcare of Florida provides for the delivery of healthcare services to selected areas of Florida.  It contracts with providers who agree to serve patients enrolled in the following healthcare plans:

Medicaid

Molina Healthcare contracts with the state government to serve as a health plan for families and individuals who qualify for government sponsored programs.  Molina delivers a wide variety of quality services for people enrolled in Medicaid and the State Children’s Health Insurance Program.  Medicaid plans are offered in Florida, California, Illinois, Michigan, Mississippi, Ohio, Puerto Rico, New Mexico, New York, South Carolina, Texas, Utah, Washington and Wisconsin.

Medicare

Molina offers Medicare Advantage plans that meet the needs of patients with Medicare or both Medicaid and Medicare coverage. Molina offers comprehensive, quality benefits and programs including access to a large selection of doctors, hospitals and other healthcare providers at little or no out-of-pocket cost.

 Integrated Medicaid/Medicare Coverage (Duals)

Molina has been selected for several dual demonstration projects as part of a member-centered healthcare model for patients who are eligible under both programs.  Molina has several years of experience in this area, allowing members to receive high quality care that meets their individual needs.

Marketplace

Known as the Exchange in some states, Molina offers Marketplace plans in many of the states where Medicaid health plans are offered.  These plans allow existing Medicaid members to stay with their providers as they transition from Medicaid to the Marketplace.  Financial barriers to quality care are removed and members’ out-of-pocket expenses are kept to a minimum.

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Molina Healthcare Medicaid Overview

Molina Healthcare of Florida has a contract with the Florida Agency for Health Care Administration to provide health care services to people with Medicaid. This is called the Statewide Medicaid Managed Care (SMMC) Program.

When you are enrolled in the Molina SMMC plan, you will be offered Medicaid services and Molina will work with a group of health care providers to meet your needs.

You can receive medical services, like doctor visits, labs, and emergency care, from a Managed Medical Assistance (MMA) plan. If you qualify for Long-Term Care (LTC) plan benefits, you may also be enrolled in Molina’s Comprehensive plan. Elders or adults with disabilities in Long-Term Care receive nursing facility and home and community-based services. ​​

All the following services are covered and must be received by providers that are part of the Molina Healthcare plan.  Prior approval may be required.

  • Adult Well Care
  • Ambulance
  • Art Therapy
  • Assistive Care Services
  • Behavioral Health Services
  • Children’s Health
  • Chiropractic
  • Dental Services
  • Dermatology
  • Diabetes Supplies and Education
  • Dialysis – Free Standing
  • Durable Medical Equipment
  • Emergency Services
  • Family Planning Services
  • Flu Vaccine
  • Hearing Services
  • Home Delivered Meals
  • Home Health Care Services
  • Hospice Services
  • Imaging Services
  • Immunizations
  • Inpatient Hospital Services
  • Interpreter Services
  • Laboratory
  • Maternity Services – Prenatal and Postpartum
  • Medically Related Lodging and Food
  • Newborn Circumcision
  • Nurse Advice Line
  • Nutritional Counseling
  • Outpatient Hospital Services
  • Over-the-Counter Pharmacy
  • Pet Therapy
  • Physician Home Services
  • Pneumonia Vaccine
  • Podiatry
  • Prescription Drugs
  • Prosthetics and Orthotics
  • Primary Care Visits
  • Shingles Vaccine
  • Sterilization
  • Therapy Services – Physical, Respiratory and Speech
  • Transplants
  • Transportation
  • Vision

For more detailed information on each of these Medicaid services offered through Molina, go here.

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Molina Healthcare Medicare Overview

Original Medicare, known as Medicare Part A and Part B, is federally funded health insurance available to all eligible beneficiaries.  Part A covers inpatient hospital care and Part B covers durable medical equipment and a variety of doctor’s services.

Those beneficiaries who want additional benefits may choose to receive coverage through Medicare Advantage plans, also known as Medicare Part C.  Advantage plans are required to cover everything that Part A and Part B do, but may also offer vision, dental, hearing and prescription drug coverage.  In Florida, Molina Healthcare offers the Molina Medicare Options Plus (HMO SNP) advantage plan which is described in much greater detail below.

Medicare enrollment is the same no matter what state you live in.  You must either be a U.S. citizen or a legal permanent resident.  You will automatically be enrolled when you reach 65 or you may receive benefits earlier if you meet certain qualifying conditions.

There are Medicare Savings Programs in Florida for those who qualify.  Residents with income that falls below a certain limit can receive assistance to help pay for out-of-pocket Medicare costs, such as premiums or deductibles. Assistance is also available for low-income beneficiaries who need help paying for prescription medication costs.

For complete information on Medicare benefits, coverage, supplemental insurance, claims and appeals, and other important information, visit the official Medicare website.

Integrated Medicaid/Medicare Coverage Overview

See Medicare Advantage information below.

Marketplace Plans Overview

Below are descriptions according to Molina’s website as of 12/03/2018

Bronze 

The Bronze plan is targeted to those who are healthy and rarely use medical services. You may receive assistance from the government that will pay for or reduce your premium. Preventive care is free but co-pays, co-insurance and deductible for most other services will be more expensive. ​

Selected benefits:  The deductible for an individual is $6,400 or $12,800 for a family.  It pays 60% of emergency room facility charges after deductible has been met.  Tier 1 lower cost generic and brand name drugs have a $20 co-pay. Dialysis is $80 after deductible is met.

Silver 100

The Silver 100 plan is the best value for most individuals or families. Silver plans get the most financial assistance.  This plan offers low premiums and the lowest out-of-pocket costs. ​​​

Selected benefits:  There is no medical deductible for an individual or a family plan.  It pays 90% of emergency room facility charges after the deductible has been met.  Urgent care deductible is $10.  Tier 1 lower cost generic and brand name drugs have a $2 co-pay. Tier 2 drugs have a $15 co-pay.  There is no charge for durable medical equipment, home infusion or home healthcare.  Dialysis is $15.

Silver 150

The Silver 150 plan is considered one of the best values for most individuals or families. All Molina Silver plans get the most financial assistance. This means you save more. This plan offers low premiums and the low out-of-pocket costs. ​​​​​

Selected benefits:  There is a $750 medical deductible for an individual or $1,500 for a family plan.  It pays 80% of emergency room facility charges after the deductible has been met.  Urgent care deductible is $20.  Tier 1 lower cost generic and brand name drugs have a $5 co-pay. Tier 2 drugs have a $30 co-pay.  There is no charge for durable medical equipment (after deductible), home infusion or home healthcare.  Dialysis is $30.

Silver 200

The Silver 200 plan is a good value for many individuals or families. All Molina Silver plans get the most financial assistance.

Selected benefits:  There is a $3,300 medical deductible for an individual or $6,600 for a family plan.  It pays 70% of emergency room facility charges after the deductible has been met.  Urgent care deductible is $50.  Tier 1 lower cost generic and brand name drugs have a $10 co-pay. Tier 2 drugs have a $60 co-pay.  There is no charge for durable medical equipment (after deductible), home infusion or home healthcare.  Dialysis is $60.

Silver 250

The Silver 250 plan is a good value for most individuals or families. All Molina Silver plans get the most financial assistance.

Selected benefits:  There is a $5,350 medical deductible for an individual or $10,700 for a family plan.  It pays 70% of emergency room facility charges after the deductible has been met.  Urgent care deductible is $50.  Tier 1 lower cost generic and brand name drugs have a $20 co-pay. Tier 2 drugs have a $60 co-pay.  There is no charge for durable medical equipment (after deductible), home infusion or home healthcare.  Dialysis is $75.

Gold

The Gold plan comes with higher monthly premiums, but low out-of-pocket costs (co-pays and co-insurance) when you receive medical care.

Selected benefits:  There is a $2,925 medical deductible for an individual or $5,850 for a family plan.  It pays 80% of emergency room facility charges after the deductible has been met.  Urgent care deductible is $35.  Tier 1 lower cost generic and brand name drugs have a $10 co-pay. Tier 2 drugs have a $50 co-pay.  There is no charge for durable medical equipment (after deductible), home infusion or home healthcare.  Dialysis is $50.

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What insurance is accepted at Molina Healthcare in Florida?

Molina Healthcare contracts with the government to provide healthcare coverage for patients enrolled in Medicaid and Medicare.  It also offers the Molina Medicare Options Plus (HMO SNP) advantage plan as well as several Health Exchange plans to meet a variety of budgets and healthcare coverage needs.

What Medicare Advantage Plans are accepted at Molina Healthcare in Florida?

Molina Healthcare offers the Molina Medicare Options Plus (HMO SNP) advantage plan which includes a network of doctors, hospitals, pharmacies, and other providers throughout Florida.

You must use providers in Molina’s network or the plan may not pay for services covered in the plan.  You must also generally use network pharmacies to fill your prescriptions for covered Part D drugs.

You can see the Molina HMO SNP provider and pharmacy directory here, or you can contact Molina Healthcare to get a copy of the provider and pharmacy directories by calling (866) 403-8293, 8 am to 8 pm, local time, seven days a week.

To join Molina Medicare Options Plus, you must be entitled to Medicare Part A, be enrolled in Medicare Part B and Medicaid by the Agency for Health Care Administration (AHCA), and live in Molina’s service area that includes Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk counties.

The Molina Medicare Options Plus plan covers everything Original Medicare covers plus several additional services.  For example, Part D drugs are covered.  Part B drugs such as chemotherapy and some drugs administered by providers are also covered.  To see a complete list of Part D formulary drugs covered under the plan as well as any restrictions, go here or call Molina  at (866) 403-8293, 8 am to 8 pm, local time, seven days a week and they will send you a copy of the formulary.

Molina Medicare Options Plus (HMO SNP) is a health plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Molina Medicare Options Plus depends on contract renewal.

Monthly premiums run from $0 to $30.30 with an annual deductible of $0 or $183 per year for in-network services.  There is a $6,700 out-of-pocket limit for Medicare covered expenses.  The deductible for Part D drugs is $0 to $83 per year, except for drugs listed on Tier 1 or Tier 2, which are excluded from the deductible.

You must continue to pay your Medicare Part B premium. As a full dual Member, the state may cover Part B premium, based upon your level of Medicaid eligibility. Benefits, premiums and/or copayments/co-insurance may change on January 1, 2019.

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Here is what the Molina Medicare Options Plus program covers:

  • Ambulance Services (Medically necessary ambulance services)
  • Cardiac and Pulmonary Rehabilitation Services
  • Chiropractic Services
  • Dental Services
  • Diabetes Programs and Supplies
  • Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
  • Doctor Office Visits
  • Durable Medical Equipment (Includes wheelchairs, oxygen, etc.)
  • Emergency Care (You may go to any emergency room if you reasonably believe you need emergency care.)
  • Hearing Services Home Health Service (Includes medically necessary intermittent skilled nursing care, home health aide services, rehabilitation services, etc.)
  • Outpatient Mental Health Care Rehabilitation Services (Occupational Therapy, Physical Therapy, Speech and Language Therapy)
  • Outpatient Services
  • Outpatient Substance Abuse Care Over-the-Counter Items Podiatry Services
  • Prosthetic Devices (Includes braces, artificial limbs and eyes, etc.)
  • Transportation Services (Routine)
  • Urgently Needed Services (This is NOT emergency care, and in most cases, is out of the service area.)
  • Vision Services
  • Wellness/Education and other Supplemental Benefit Programs
  • Inpatient Hospital Care (Includes Substance Abuse and Rehabilitation Services)
  • Inpatient Mental Health Care
  • Skilled Nursing Facility (SNF) (In a Medicare-certified skilled nursing facility)
  • Kidney Disease and Conditions Preventive Services
  • Outpatient Prescription Drugs
  • Assistive Care Services
  • Behavioral Health / Targeted Case Management Service
  • Clinic Services
  • Community Mental Health Services
  • Dialysis Center Services
  • Federally Qualified Health Center Services
  • Mental Health Case Management
  • Nurse Practitioner Services
  • Physician Assistant Services
  • Registered Physical Therapist Services
  • Rural Health Center Services
  • Screening Services

This information is not a complete description of benefits. Call (866) 553-9494 for more information. Authorization and/or referral may be required.

You are eligible to join the Molina Medicare Options Plus plan if:

  • You reside in the Molina Medicare Options Plus geographic service area, and:
    • you are entitled to Medicare Part A,
    • you are enrolled in Medicare Part B; and you or Medicaid continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party,
    • you are entitled to Medicaid, and
    • you do not have end stage renal disease (ESRD) with limited exceptions (such as if you develop ESRD when you are already a member of a plan that is offered, or you were a member of a different plan that was terminated).

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What is the SilverSneakers Program?

The SilverSneakers Fitness program was founded in 1992 with the goals of improving the physical, mental and emotional health of older Americans.  It has grown to become a nationwide network of fitness and wellness facilities that serve more than 12 million people.

Targeting people 65 and older, SilverSneakers offers a diverse range of classes from low impact to high intensity, tailored to meet the individual fitness goals of participants.  Classes include yoga, weight training, Latin dance, aqua-aerobics and dozens of others, each uniquely designed and taught by certified instructors.

Not only does it offer a variety of fitness and social benefits to participants, in many cases a SilverSneakers membership may be free as one of the benefits of several Medicare Advantage programs.

Molina Medicare Options Plus covers memberships to participating fitness centers and select YMCAs nationwide through the FitnessCoach® program. Fitness centers may include services like exercise equipment, free weights or group exercise classes. You can find participating locations near you by searching online at  FitnessCoach.com.

If you are unable to visit a fitness center or prefer to work out from home, you can enroll in the FitnessCoach Home Fitness Program and choose up to two home fitness kits per calendar year.

To learn more, call Molina Healthcare at (866) 403-8293, TTY 711, 8 am to 8 pm, seven days a week.

Where is Molina Healthcare in Florida located?

Molina operates in 37 Florida counties, but does not offer all services in all counties.

The service area for the Molina Medicare Options Plus HMO SNP and Health Insurance Marketplace plans are offered in seven counties:

  • Broward County
  • Palm Beach County
  • Miami-Dade County
  • Pinellas County
  • Polk County
  • Osceola County
  • Duval (Marketplace only)

Medicaid Providers

Molina Healthcare of Florida contracts with hundreds of locations throughout Florida in all 37 counties it serves.  The organization publishes Medicaid Florida Provider Directories that list all locations where members can obtain services.  Each directory has several hundred pages of listings.

Region 1 – To access the July 2018 directory that covers Escambia, Okaloosa, Santa Rosa and Walton counties, go here.

Region 4- To access the July 2018 directory that covers Baker, Clay, Duval, Flager, Nassau, Saint Johns, and Volusia counties, go here.

Region 6 – To access the July 2018 directory that covers Hardee, Highlands, Hillsborough, Manatee and Polk counties, go here.

Region 7 – To access the July 2018 directory that covers Brevard, Orange, Osceola, and Seminole counties, go here.

Region 8 – To access the July 2018 directory that covers Charlotte, Collier, De Soto, Glades, Hendry, Lee and Sarasota counties, go here.

Region 9 – To access the July 2018 directory that covers Broward, Indian River, Martin, Okeechobee, Palm Beach and Saint Lucie counties, go here.

Region 11 – To access the July 2018 directory that covers Broward, Miami Dade and Monroe counties, go here.

The list of providers may change with new doctors being added, or changes to doctors’ hours or addresses, or doctors who leave the plan.

You can visit www.molinahealthcare.com or call Molina Member Services at (866) 472-4585, Monday through Friday from 8 am to 7 pm if you have questions about providers

Molina Provider Search Tools

Molina offers several provider search tools that can easily be accessed.

Find a Pharmacy Search Tool

This allows members to find Pharmacies that work with Medicaid, Health Insurance Marketplace or Molina Medicare Options Plus HMO SNP.

To access the Find a Pharmacy Search Tool, go here.

Find a Provider Search Tool

Molina Healthcare of Florida offers a “Find a Provider” search tool that allows members to locate Long Term Care, Medicaid, Medicare and Molina Marketplace providers.

You can search by location, including by city, zip or cunty and then enter the type of coverage you have followed by the provider type (dental, hospice, primary care provider, specialist, etc.).

To access the Find a Provider Search Tool, go here.

Find a Hospital Search Tool

Molina also has a Hospital Search Tool that operates in a similar manner to the Provider Search Tool.

To access the Find a Hospital Search Tool, go here.

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