Frequently Asked Questions

In general, you must receive covered services from participating providers; otherwise, the services are not covered, you will be 100% responsible for payment to the non-participating provider, and the payments will not apply to your deductible or annual out-of-pocket maximum. However, You may receive services from a non-participating provider for the following:

• Emergency services
• Post-stabilization services, unless the member waives balance billing protections
• Air ambulance services
• Services from a non-participating provider that are subject to prior authorization
• Exceptions described in the member Agreement's "Access to Care" section in the subsections titled "Out-of-Area Urgent Care Services," "Non-Participating Provider at a Participating Provider Facility," "No Participating Provider to Provide a Covered Service," "Continuity of Care," "Transition of Care," and "Second Opinions."

To locate a participating provider, please refer to the provider directory at MolinaMarketplace.com or call Member Services. Because non-participating providers are not in Molina's contracted provider network, unless balance billing protections afforded to the member through federal or state law apply, they may balance bill members for the difference between Molina's allowed amount and the rate that they charge.

Once you have obtained covered services from a participating provider, the provider is responsible for submission of claims to Molina for determination of payment under your plan. You are not responsible for submitting claims to Molina for payment of benefits under your plan.

However, if a participating provider fails to submit a claim, you may wish to send receipts for covered services to Molina. With the exception of any required cost sharing amounts (such as a deductible, copayment or coinsurance), if you have paid for a covered service or prescription that was approved or does not require approval, Molina will pay you back. You must submit your claim for reimbursement within 12 months from the date you made the payment.

If Molina is not the primary payer under coordination of benefits or third-party liability, the provider must submit claims to Molina within 30 calendar days after final determination by the primary payer. Except as otherwise provided by state law, any claims that are not submitted to Molina within these timelines are not eligible for payment and provider waives any right to payment.

Please refer to your evidence of coverage, policy or certificate. You will need to mail a copy of the bill from the doctor, hospital or pharmacy and a copy of your receipt and the Member’s Name, Subscriber ID, and Date of Birth. If the bill is for a prescription, you will need to include a copy of the prescription label. Mail this information to Molina’s customer support center at the following address:

Molina Healthcare of California
Member Services
200 Oceangate, Suite 100
Long Beach, CA 90802

1 (888) 858-2150

A grace period is a period of time after a member’s premium payment is due and has not been paid in full.  If a subscriber hasn’t made full payment, they may do so during the grace period and avoid losing their coverage.  The length of time for the grace period is determined by whether or not the subscriber receives an advance payment of the premium tax credit (APTC). 

• Grace Period for Subscribers with No APTC: If a subscriber does not receive an APTC, Molina will give the subscriber and dependents a 30-calendar-day grace period before cancelling or not renewing coverage due to failure to pay the premium. The grace period will begin the day the Notice of Start of Grace Period is dated and no earlier than the day after the last date of paid coverage. Molina will continue to provide coverage pursuant to the terms of the Agreement, including paying for covered services received during the 30-calendar-day grace period. If the subscriber does not pay the premium by the end of the grace period, the Agreement will be cancelled at the end of the grace period. The subscriber will still be responsible for any unpaid premium owed for the grace period. Termination or nonrenewal of the Agreement for non-payment will be effective as of 11:59 p.m. on the last day of the grace period.

• Grace Period for Subscribers with APTCs: If a subscriber receives an APTC, Molina will give the subscriber and dependents a 3-month grace period before cancelling or not renewing coverage due to failure to pay the premium. The grace period will begin the first day after the last day of paid coverage.  Molina will pay for covered services received during the first month of the 3-month grace period.  If the subscriber does not pay the premium by the end of the first month of the 3-month grace period, coverage under the plan will be suspended and Molina will not pay for covered services after the first month of the grace period until Molina receives the delinquent premiums.  If all premiums due and owing are not received by the end of the 3-month grace period, the Agreement will be retroactively terminated at the end of the first month of the grace period. Termination or nonrenewal of the Agreement for non-payment will be effective as of 12:01 a.m. of the day after the last date of paid coverage.

A prior authorization is an approval from Molina for a requested health care service, treatment plan, prescription drug or durable medical equipment. A prior authorization confirms that the requested service or item is medically necessary and is covered under your plan. Molina’s Medical Director and your doctor work together to determine the medical necessity of covered services before the care or service is given. This is sometimes also called prior approval.

For a list of covered services that require prior authorization, please visit www.MolinaMarketplace.com/CAGetCare.. If you do not obtain prior authorization for the specified services, claims for benefit payment may be denied, impacting your out of pocket costs.

Routine prior authorization requests will be processed within 5 business days of receiving complete information from your doctor, and Molina will respond to prior authorization requests within 14 calendar days.

Medical conditions that may cause a serious threat to your health are processed within 72 hours from receipt of all information, or shorter as required by law.

Molina has a list of drugs, devices, and supplies that are covered under the plan's pharmacy benefit. The list is known as the formulary. The formulary shows prescription and over-the-counter products plan members can get from a pharmacy using Molina coverage. It also shows coverage requirements, limitations, or restrictions on the listed products. The formulary is available at www.MolinaMarketplace.com. A hardcopy is also available upon request.

If your prescription drug is not listed on the formulary, your provider may request a formulary exception by sending a form and supporting facts to let Molina know how the drug is medically necessary for your condition. The process is similar to requesting prior authorization for a formulary drug.

The pharmacy "Prescription Drug Prior Authorization Request Form" and instructions for completing the request can be found here.

Molina Marketplace
Member Phone: (888) 858-2150
Provider Phone: (855) 322-4075
Fax: (866) 508-6445

If the request is approved, we will notify your provider. If it is not approved, we will notify you and your provider, including the reasons why. Drugs that are not on the formulary may cost you more than similar drugs that are on the formulary if covered on exception.

There are two types of formulary exception requests:

Expedited exception request – this is for urgent circumstances that may seriously jeopardize your life, health, or ability to regain maximum function; or for requesting nonformulary prescription drugs you have already been taking for a while. Drug samples given to you by a provider or a drug maker will not count as drugs you have been taking for a while. To have your request expedited, indicate on the form that the request is urgent.

Standard exception request – this is for non-urgent circumstances.

Notification - following your request, we will send you and/or your provider notification of our decision no later than:

• 24 hours following receipt of request for expedited exception request
• 72 hours following receipt of request for standard exception request

The Engage Cost Estimator Tool is for Molina Marketplace members to get a cost estimate for a procedure or service before receiving medical care from both in and out-of-network providers.

1. Login to your MyMolina member portal
2. Click on the “My Coverage” tab
3. Scroll to the “Cost Estimator” section
4. Click on the “Cost Estimator” button
5. In the new webpage, enter your member login and password
6. In the new webpage, use the tool to get your estimate

Estimates consider the plan of benefits, benefit accumulations, benefit limits, and out-of-pocket accumulations at the time of the inquiry.

No, they are only estimates and will not be the final cost. Estimates do not include unexpected charges for unexpected services/procedures or balance billing from out-of-network providers. Contact your provider for the final cost.

Estimates are not a guarantee that benefits will be provided for the service. Contact your provider to confirm services for any medical care.

In your MyMolina portal, go to the ‘Contact Us’ to find your Customer Support telephone number or send a message to us.

• Your estimates are not saving or printing.
• You need your estimates mailed to you.
• The Engage Cost Estimator Tool is showing incorrect information.

Open enrollment for 2024 is November 1, 2023 through January 31, 2024.

Complete your enrollment application by December 31, 2023 for a January 1, 2024 effective date.

• You get married or enter into a domestic partnership
• You have or adopt a child, or place a child in adoption or in a foster home
• You lose your health coverage, including no longer being eligible for Medi-Cal or losing your coverage through your job
• You change where you permanently live or move to another region of the state where plan options are different
• You are released from jail or prison
• You have exhausted your COBRA coverage
• You are already enrolled in a Covered California plan and you become newly eligible or ineligible for tax credits based on your income
• You turn 26 and can no longer be covered by your parents’ plan
• You turn 19 years old and are no longer eligible for a child-only plan.
• You’re no longer covered by a college health plan
• You return from active-duty military service
• You become a citizen, national or lawfully present individual
• If you are a member of a federally recognized American Indian or Alaska Native tribe, you can enroll anytime and change plans no more than once per month.
• If you apply for health coverage through Covered California before March 31st or Medi-Cal after March 31st and feel you were incorrectly denied.
• If your enrollment was wrong due to an error, misrepresentation or misconduct of your health insurance company, Covered California or a non-Covered California entity.
• Covered California determines you experienced an exceptional circumstance

Other qualifying life events may apply. For more information, visit Covered California.

• If you apply between November 1, 2023, and December 15, 2023, the effective date of your coverage is January 1, 2024.
• If you apply between December 16, 2023, and January 31, 2024, the effective date of your coverage is February 1, 2024.
• The effective date of coverage will be determined by the Marketplace. The Marketplace and Molina will provide special monthly enrollment periods for eligible American Indians or Alaska Natives.

Within 10 days after you pay your first premium. For coverage starting on the first of the month we will send out ID cards approximately the 26th of the month.

To make a payment for your monthly premium, go to MyMolina.com and click on the $ icon. We provide several payment options for your convenience. We accept Visa, MasterCard and Discover Card or electronic check. You can also sign up for automatic payments through AutoPay. It is convenient and worry free!

For additional ways visit our Make a Payment page.

• If you are a new member, you will receive a paper invoice within 7-10 business days after enrollment.

• If you are a renewing member, you will receive an invoice by the 15^th of every month. 

To determine which participating provider is in your area go to the Provider Online Directory and follow the steps below.

1. Select Molina Marketplace under Plan/Program located at the top of the page.
2. You have the option to enter “City”, “County”, “State” or “Zip Code”.
3. Search options include “Browse by Category” and “Search Bar” where you can enter a name or a specialty to search for a doctor or facility.

To determine which participating provider is accepting new patients go to the Provider Online Directory and follow the steps below.

1. Select Molina Marketplace under Plan/Program located at the top of the page
2. You have the option to enter “City”, “County”, “State” or “Zip Code”.
3. Search options include “Browse by Category”, “Search Bar” where you can enter a name or a specialty to search for a doctor or facility.
4. Select View Only “Accepting New Patients”

The services offered by Teladoc are also available in person or via telemedicine (if available) through your primary care provider or another Molina network provider.

Contact Covered California at (800) 300-1506 or visit CoveredCA.com to:

• Update your address and contact information
• Report any changes to your income
• Update information such as citizenship and proof of residency
• Make changes to your health coverage
• Ask questions about financial assistance
• Cancel your coverage
• Request a copy of your Form 1095-A

Contact us or visit MyMolina.com to:

• Make a payment or ask a question about billing and payments
• Request a new membership ID card
• Learn more about benefits and eligibility
• Get help finding doctors or other providers
• Find out how claims for services were paid
• Change primary care physician

• Access your digital ID card and download view it to your smart phone, or print it or request a new ID card to be sent to your current address on file with Molina
• Choose or change your Primary Care Physician (PCP)
• View Billing Information
• Make a Payment
• Sign up for automatic monthly payment through AutoPay
• Check to see if we cover your prescription drugs
• Quick links to benefit coverage and much more!

Yes. You may select a different health plan until December 31, for a January 1 start date. Please go to Covered California to review your plan options.

Please go to Covered California and update your information.

Yes, you and your dependents will be automatically enrolled in Molina, if they were covered by your previous insurer.

If you are eligible for tax credits and your family size and/or income has not changed, you will continue to receive tax credits.

Log in to www.MyMolina.com to view your personal benefit information. If you don’t already have an account, you can register for one using your Member ID.

Yes, but you need to continue to pay your current/previous insurer until the end of the year.

Log in to www.MyMolina.com to view your personal benefit information. If you don’t already have an account, you can register for one using your Member ID.

After you make your initial payment, you will receive your ID card within 10 days.

While all the efforts are being made to keep your premiums low, premiums may increase depending on your family size and/or income. You will be notified by Molina through your monthly invoice on the exact monthly premium amounts.

For your convenience, we have a Provider Online Directory where you can search for available choices in your area. Go to Provider Online Directory

Yes, If your doctor is in Molina’s network. To find out if your doctor is in Molina’s network, go to Provider Online Directory

To view all of our covered formularies, go to Molina Healthcare Drug Formulary

You can contact member services to answer any questions you may have