Your Idaho Medicare member programs and rewards

Living with health problems and managing them can be hard. We offer special programs to support you.

Case Management is when a nurse works with you and your main provider. The nurse will help you get the care you need. 

Complex Case Management program is for members with difficult health. Both programs allow you to work with a nurse. The nurse can help you learn more about your health problems. He or she can teach you how to better manage them.

There are many ways you can be referred to this program. One way to enroll is through your doctor. You also can self-refer to the program by calling Member Services. There are certain requirements that you must meet.

This program is voluntary and is offered at no cost to you. You can choose to be removed from the program at any time.

Health education programs 

Molina Medicare has various programs and services to offer you. There are many ways you can be referred to a program or service. One way to enroll is through your provider. You also can self-refer to the program. There are certain requirements that you must meet. You can choose to be removed from these programs at any time.

You can stay healthier when you ask for guided help with:

• Weight Control Program

This program is for members who may need help controlling their weight. The weight control program is provided for Molina Medicare members. You will learn about healthy eating and exercise. You may be able to go to classes in your area, if classes are offered. 

• SOLERA HEALTH | MEDICARE DIABETES PREVENTION PROGRAM

Molina Healthcare has partnered with Solera Health to offer the Prevention Program.

This program helps match you with support that fits your needs. This program can help you build healthy habits and lower your risk for type 2 diabetes.

The program may include the following:  

• A focus on healthier food choices and greater activity levels
• 16 weekly lessons over the span of six months, followed by monthly maintenance sessions
• Interactions with a lifestyle health coach
• Small group, in-person classes for encouragement and support

Visit solera4me.com/molina or call (888) 305-6058 (TTY: 711), Monday through Friday, 9 a.m. to 9 p.m. ET to see if you pre-qualify.

• Smoking Cessation Program

This program is for members who are ready to kick the smoking habit. The program is for smokers who are over 18 years of age. You will be asked about your readiness to stop smoking. If you are ready and have the support to take this important step, you may be eligible to join. The program is done over the phone and lasts for six months.

• You will be mailed a kit with materials to help you stop this habit.
• A stop smoking counselor will call you to offer support.
• You will also be given a phone number that you can call anytime you need help.

• Women’s Healthcare Services
• You can get women's health care services from any doctor who has a contract with Molina Medicare. You do not need a referral from your main provider. This may include services such as:
  
  • Pap tests
  • Mammograms
  • Family planning

• Motherhood Matters^® Pregnancy Program
• • This program will help pregnant women get the education and services needed for a healthy pregnancy. You will be mailed a workbook and other resources. You will be able to talk with a Care Manager about any questions you may have during your pregnancy. Also, you will learn ways to stay healthy during and after your pregnancy.

• Preventive Health Guidelines

• • When to Get an Exam
  • • Do you know when you need an exam or other preventive health services? Our Preventive Health Guidelines outline recommended exams and services for you and your family. They provide basic suggestions for healthy children and adults without known medical issues. They should not replace your doctor’s advice.

• • Do your part to stay healthy!

• Take a few moments to read the Guidelines to Keep You Healthy . You can also view the Immunization Schedules. The guides suggest exams and shots to keep you healthy. Molina covers health care services that prevent illness.

• Write down any questions you may have. Take these questions to your next exam.
• Tell your provider about any health problems you or your children are having.
• Make sure you do not miss your appointments.
• If you miss your appointment, call your doctor to reschedule right away.

Effective January 1, 2010, Molina Medicare covers all standard and FDA‑approved rapid HIV tests.

• 1. We cover yearly HIV testing for members who may be at higher risk, including:
     • People who have had unprotected sex with multiple partners
     • People who use or have used injection drugs
     • People who exchange sex for money or drugs, or have partners who do
     • People whose partners have HIV, are bisexual, or use injection drugs
     • People being treated for sexually transmitted diseases
     • People who received a blood transfusion between 1978 and 1985
     • Anyone who requests an HIV test, even if they do not identify specific risk factors
  2. We also cover HIV testing for pregnant members, which may be done when pregnancy is identified, during the third trimester, and during labor.

Molina Newsfeed – FAQs

What is the Molina Newsfeed?
The Molina Newsfeed is a mobile service from Molina Healthcare. It gives you important account or plan information. You can get updates with ease when you need them.

How do I get back to the Molina Newsfeed?
If you cannot find it, open the first text from 73529. Click the link in that text. It will take you back to your Molina Newsfeed.

What are the benefits of the Molina Newsfeed?
The Molina Newsfeed helps you get quick and easy updates. It gives you simple, timely, and personal messages. This helps us give you better service.

What are the types of communications I may receive?
You might receive account, service, product information and more.

Am I charged for any notifications I receive on my mobile phone?
No, this is a no-cost service. Depending on your mobile plan, standard message and data rates may apply.

Can I opt out of mobile notifications?
Yes. You are in complete control of this service and you can stop at any time. To turn off this service, text STOP to Molina Newsfeed 73529.

Privacy Policy and Terms of Use
Molina Healthcare Privacy Policy and Terms & Conditions 

Molina Healthcare Member Services
(844) 239-4913 (TTY: 711)
Notice of Non-Discrimination and Language Assistance Services

Silver & Fit fitness program

You can join a local fitness center or get a home fitness kit at no cost. A caregiver may join you to help you feel safe.

Start here  https://silverandfit.com or call (877) 427-4711 (TTY:711) Monday to Friday, 8 a.m. to 6 p.m., local time.

Molina Guided Care

Guided Care supports members with serious illnesses, such as:

• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure (CHF)
• A combination of serious conditions like diabetes or stroke

Our focus is to reduce pain, stress, and confusion.

Members who begin Guided Care can see:

• Improved symptoms
• Reduced hospitalizations
• Fewer unnecessary or unwanted treatments
• Support for both the member and their family and caregivers

We want to give you and your family the best quality of life possible.

Guided Care may be available to those who have Medicare Advantage or who have both Medicare and Medicaid, also known as D-SNP (Dual Eligible – Special Needs Plan). 

Members with Medicare Advantage or D‑SNP may qualify. Your main provider can refer you to a Guided Care doctor. Talk to your provider if you have a serious condition. Your provider can tell you if you should start Guided Care.

There are forms and approvals based on what the caregiver needs to do. Some of these forms come from the state.

Protected Health Information Form: The member or their Personal Representative can complete this form. This lets Molina share PHI but does not require them to do so.

Appointment of Representative Form (CMS-1696):An appointed representative is someone you trust. This may be a family member, friend, doctor or another approved person. They can act for you when you file a grievance, coverage request or appeal

If you want to name a representative, you both must fill out this form. Mail the form to Molina Healthcare at:

Molina Healthcare
Attn: Service Fulfillment
200 Oceangate Ste 100
Long Beach, CA 90802

Durable Power of Attorney: If a member needs help in making health care choices, they should fill out the Durable Power of Attorney form for their state, which can be found here.

This information is not legal advice. Please talk to a lawyer for help with legal questions.

For more information about Molina Guided Care, visit MolinaGuidedCare.com

Local support for members and caregivers can be found at MolinaHelpFinder.com.

Supplemental Vision

We have partnered with a Vision Vendor for added value.

Supplemental Vision services covered include, but not limited to:

• One routine eye exam every calendar year
• An eyewear allowance

You can use your eyewear allowance to purchase:

• Contact lenses*
• Eyeglasses (lenses and frames)
• Eyeglass lenses and / or frames
• Upgrades (such as, tinted, U-V, polarized or photochromatic lenses).

* You may use your eyewear allowance for contacts. You must pay for eyewear that costs more than your allowance.

You pay no money for one routine eye exam each year. You have an eyewear allowance every calendar year.

To find a vision provider near you:

Search online – using our supplemental vision provider online search tool at vision.

Supplemental benefits help pay for items Medicare does not cover. You can use these benefits only during the plan year. You must be enrolled when you get the service.

Supplemental Dental

Molina Medicare Complete Care Select (HMO D-SNP)

Original Medicare does not cover preventive dental care like cleanings or X‑rays.

We cover additional dental benefits that Original Medicare does not cover.

These benefits are detailed separately below under the Dental services (Supplemental) category. Supplemental dental services covered include, but not limited to:

• Preventive Dental
• Oral Exams
• Prophylaxis(cleaning)
• Fluoride Treatment
• Dental X-rays

Comprehensive Dental

All comprehensive dental services listed below are covered up to the annual plan maximum benefit coverage amount:

• Extractions
• Endodontics
• Restorative services
• Intraoral and extraoral incision and drainage
• Dentures and denture adjustments
• Non-routine services (scaling, full mouth debridement, periodontal maintenance, and palliative emergency treatment)
• Other services such as deep sedation with oral surgery and intravenous with oral surgery

To find an in-network dental provider close to you:

Search online – using our supplemental dental provider online search tool at dental

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage.

Molina Medicare Complete Care (HMO D-SNP)

Preventive and comprehensive dental services are provided by MCNA (for Idaho Smiles program).

Supplemental Hearing

• Our plan covers one routine hearing exam every year.
• One fitting for hearing aid/evaluation every year.
• Up to 2 pre-selected hearing aids covered from a plan-approved doctor every 2 years.

Meals Benefits

Molina Medicare Complete Care (HMO D-SNP)

• After a surgery or inpatient stay, you may get 28 meals. Meals arrive over two weeks.
  Eligibility is based on your needs. Maximum of 56 meals and 4 weeks per year.
• Members with diabetes may be eligible for 2 meals per day, up to 12 weeks, maximum of 168 meals.

Molina Medicare Complete Care Select (HMO D-SNP)

• After surgery or inpatient hospitalization, you may get 28 meals. Meals arrive over two weeks. Maximum of 56 meals and 4 weeks per year.

Pre-funded Debit Card (MyChoice Card)

You get a monthly allowance on your MyChoice card. You may use it for approved supplemental benefits such as:

• Over-the-Counter items
• Transportation (Non-Emergency)
• Food and Produce*
• Transportation non-medical needs*
• Utilities*

Funds are loaded onto the card each month. Unused allowances do not carry over to the next month.

*Eligibility requirements applicable

Over the Counter (OTC) Benefit

You get a monthly allowance on your MyChoice card. You can use it for OTC items like vitamins, sunscreen, pain relief, bandages and cold meds. Unused allowance does not carry over to the next month.

OTC hearing aids are covered and included in the combined OTC allowance.

You can use your pre-funded debit card (MyChoice card): 

• In Store: At select participating retail locations.
• Online: Visit www.Molina.NationsBenefits.com
• By Phone: Call (877) 208-9243 (TTY: 711) Monday to Friday, 8 a.m. to 7 p.m., EST.
• By Mail: Fill out and return the OTC Order Form in the OTC Product Catalog.

Things to remember:

• You can visit www.Molina.NationsBenefits.com for information about your pre-funded debit card (MyChoice card).

Please see MyChoice card section for a complete list of benefits and services.

Personal Emergency Response System (PERS)

Molina Medicare Complete Care Select (HMO D-SNP): When authorized, we will provide an in-home device to notify the appropriate personnel in the event of an emergency (e.g., a fall). Case Management review is required.

Molina Medicare Complete Care (HMO D-SNP) does not offer Personal Emergency Response System (PERS).

Special Supplemental Benefits for Chronic Illnesses

You get a monthly allowance on your MyChoice card. You may use for supplemental plan benefits such as:

• Food and produce
• Utility bills (electricity, natural gas, and water)
• Transportation non-medical needs

Please see the MyChoice Card section for a complete list of benefits and services. Unused allowance does not carry over to next month.

Members must meet the criteria outlined in Chapter 4 of the Evidence of Coverage.

24-Hour Nurse Advice Line

You can call the 24‑hour Nurse Advice Line for help 24 hours a day, 365 days a year. Nurses can look up trusted health information and guide you based on your symptoms.

Call the Nurse Advice Line. You can talk to a nurse in your language about any health problem.

Our call center has been reviewed and approved by a national quality review organization (URAC) since 2007. They will help you 24 hours a day, 7 days a week.

English & Spanish: (844) 847-9499

For the deaf and hard of hearing, please call TTY: 711

Non-Emergency Medical Transportation

You get a monthly allowance for transportation. It does not correspond to a set number of “rides”. You can use it to pay for non‑emergency medical rides. 

Things to remember:

• Unused funds do not roll over.
• You may use your allowance for rides on:
• • ride-hailing applications,
  • on taxi services,
  • bus passes
  • rail cards, or other forms of public transit

• Use this allowance only for services not covered by Original Medicare or Medicaid.

See MyChoice card section for a full list of services in this combined allowance. 

Virtual Care

Virtual care through additional telehealth services – search the Molina Provider Online Directory to find a Primary Care Physician who is able to provide services online or over the phone.

Virtual Care means:

• Convenient online or phone visits, from wherever you are.
• You’re treated at no cost! Visits are no cost for Molina members.

Call 911 or go to the emergency room for any emergency.

Care Coordination

Care Coordination helps members with long‑term health needs. This health problem can be either physical or mental.

A Care Coordinator’s job is to:

• Help you find services that are not benefits. This could be physical therapy with the schools or "Meals on Wheels".
• Help you access services that you are eligible to receive.
• Help coordinate appointments and tests.
• Help coordinate transportation.
• Help access resources to help individuals with special health care needs

How can I help my Care Coordinator help me?

• Write down your questions. This will help you remember things when you have a lot to talk about.

• Tell your Care Coordinator about all your appointments and tests. Not being aware of all the details of your case can make it harder for your Care Coordinator to help you.

Caregiving

Caregiving means helping someone stay safe and healthy at home. A caregiver can be a family member, friend, or neighbor. Caregiving needs can be both planned and unplanned.

Unplanned caregiving needs can happen in times of:

• An unexpected surgery
• An unexpected health issue such as a stroke

Planned caregiving is when a health issue or surgery is known before. Caregivers are needed to help a member with long-term sickness. For Medicare members, many often want to age-in-place in their own home. Having a part-time or full-time caregiver can help them.

Caregivers are needed to support those who cannot handle their daily needs without help. Some caregivers want help with benefits or choices.
Your Personal Representative can complete needed forms.

Protected Health Information Form: The member or their Personal Representative can complete this form. This lets Molina share PHI but does not require them to do so.

Appointment of Representative Form (CMS-1696):This can be a family member, friend, doctor or other person. They can act on your behalf in filing a grievance, coverage determination or appeal. You and your representative must complete this form. Please mail it to Molina Healthcare at:

Molina Healthcare
Attn: Service Fulfillment
200 Oceangate Ste 100
Long Beach, CA 90802

Durable Power of Attorney: If you need help making health care choices, fill out a Durable Power of Attorney form.

This information does not, and is not intended to, constitute legal advice. Please talk to your lawyer for advice.

For more help about caregiving, including a caregiving checklist, and forms, visit MolinaCaregiving.com

Local support for members and caregivers can be found at findhelp.org and care.com

 

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