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We Want to Give You Good Care!

 

Molina Medicare works with your providers to give you good health care. We make choices about your care based on what you need. We also look at your benefits. We do not reward providers to deny you care. We also do not reward staff or other people to deny you care or give you less care. We do not pay extra money to providers or our staff members to deny tests or treatments that you need to get better or stay healthy.

 

Please call Member Services, if you ever have a concern about your health care. You can also talk to our nurses about getting needed care. Our nurse staff is here to take your call 7 days a week (except holidays) during normal business hours. They can answer questions about how we make health care choices.

 

We also want to remind you that Molina Medicare has a Nurse Advice Line to help answer questions you may have about your health. There are nurses ready to help you 24 hours a day, 7 days a week.

 

Click here for our frequently asked questions.

 

Get expert health care from the comfort of home.

 

Molina Healthcare is pleased to offer you virtual care through additional telehealth services. You can simply 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 free for Molina members.

 

If at any point your symptoms worsen or you feel like you are experiencing a medical emergency, call 911 or proceed to the nearest emergency room.

 

 

Living with health problems and managing them can be hard. We have programs that can help. Case Management is when a trained nurse at Molina Medicare works with you and your Primary Care Provider (PCP). The nurse will help you get the care you need.

 

We also have a Complex Case Management program for members with difficult health problems who need extra help with their health care needs. Both programs allow you to work with a nurse. The nurse can help you learn more about your health problems. They can teach you how to better manage your health problems.

 

The nurse also will work with your family or others who help care for you. The nurse will work with your provider to make sure you get the care you need.

 

There are many ways you can be referred to a program. One way to enroll is through your provider. 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.

 

Care Coordination is a service for any adult or child who is receiving health services for an ongoing health problem. 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 and/or their caregivers deal with day to day stress.

 

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.

 

For more information or if you have questions, please call Member Services. If you feel that you need emergency treatment, please get help first or call 911 .

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001

 

You can get a ride to your health care appointments such as office visits, physical therapy, dialysis or to pick up prescriptions at your local pharmacy. If you have recurring appointments, these can be scheduled ahead of time.

 

• Transportation Reservation Number:(505) 836-7995 & (833) 707-7100 toll free (TTY: 711),24 hours a day, 7 days a week.

 

If you need to cancel your transportation services, please call 24 hours in advance of your appointment.

 

Things to remember:

 

• It is important to call 2 calendar days in advance of your appointment to schedule the transportation.
• If you need to cancel your transportation services, please call 24 hours in advance of your appointment.
• If you require special assistance such as wheelchair accessible, please mention that when making your appointment so the most appropriate transportation can be arranged.
• You will need prior authorization if you travel over 100 miles for a one-way trip.

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-002

 

If you are on a Molina New Mexico Medicaid plan, your benefits include unlimited non-emergency medical transportation for medically necessary covered services.

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

For additional assistance, please call Member Services.

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001

In general, preventive dental services (such as cleaning, routine dental exams, and dental x-rays) are not covered by Original Medicare.

 

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 such as scaling, full month 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 can:

Search online – using our supplemental dental provider online search tool at MolinaHealthcare.com/Medicare

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-002 does not offer Supplemental Dental

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001

We have partnered with a Vision Vendor to give you more value for your routine vision needs!

 

 

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).

 

*If you choose contact lenses, your eyewear allowance can also be used to pay down all or a portion of your contact lens fitting fee.  You are responsible for paying for any corrective eyewear over the limit of the plan’s eyewear allowance.

 

You pay $0 for up to one routine eye exam (and refraction) for eyeglasses every calendar year. You have an eyewear allowance every calendar year.

 

For your routine eye exam, to find an in-network routine preventive vision provider close to you can:

 

Search online – using our supplemental vision provider online search tool at MolinaHealthcare.com/Medicare

 

Supplemental benefits are offered by the plan to help with items or services that are generally not covered by Medicare.  All benefits must be used in the plan year and are only available if you are enrolled at the time services are rendered. 

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-002

 

You get a Vision exam to diagnose/treat diseases of the eye (including yearly glaucoma screening): $0 copay for eyeglasses or contact lenses after cataract surgery.

 

If you are on a Molina New Mexico Medicaid plan, your benefits include $0 for one routine eye exam (and refraction) for eyeglasses every three years.

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001 and H8845-007-002

 

Our plan covers one routine hearing exam every year, one fitting for hearing aid/evaluation every year and up to 2 pre-selected hearing aids covered from a plan approved provider every 2 years.

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001

 

Immediately following a surgery, inpatient hospitalization, or for a chronic or medical condition requiring you to stay at home, you may be eligible for a standard meal cycle. This includes a 2-week menu with up to 28 delivered meals based on your needs. You may receive a maximum of 56 meals over a 4-week period each year.

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-002

 

Immediately following a surgery or inpatient hospitalization, you may be eligible for a standard meal cycle with a 2-week menu and a total of 28 delivered meals, based on member need. Maximum of 56 meals and 4 weeks per year.

If you have an eligible chronic condition, you can receive 14 meals each month, for 12 months in the calendar year (168 total meals). Must meet criteria approved by the plan.

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001 and H8845-007-002

You have a combined monthly allowance on your pre-funded debit card (MyChoice card) for non-prescription OTC health and wellness items like vitamins, sunscreen, pain relievers, bandages, and cough and cold medicine. 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 com for information about your pre-funded debit card (MyChoice card).

 

Please see the pre-funded debit card (MyChoice card) section for a complete list of benefit and services that are included in the combined allowance.

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

OTC Benefit

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001 and H8845-007-002

 

If you are on a Molina New Mexico Medicaid plan, your benefits include a Personal emergency response system (PERS) available to members who qualify. Please see your Evidence of Coverage (EOC) for more information on the benefit.

 

Molina Medicare Complete Care (HMO D-SNP) H8845-007-001 and H8845-007-002

 

You receive a combined monthly allowance on a pre-funded debit card that may be used towards select supplemental plan benefits such as:

 

• Over-the-Counter items
• Food and Produce*
• Transportation non-medical needs*
• Utilities*

 

Funds are loaded onto the card each month. At the end of each month, any unused allocated funds will not carry out to the following month or plan year.

 

*Eligibility requirements applicable

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina Medicare Complete Care (HMO D-SNP)

 

The Silver&Fit® program offers you access to participating fitness centers and/or a Home Fitness Kit.

 

If you have a caregiver, you can bring them with you to help you use the fitness center’s services and equipment.

 

There are two ways to start using your Silver&Fit benefit:

 

• Go to SilverandFit.com. After registering on the website, you can find fitness centers, pick a Home Fitness Kit, and search for online classes.
• Call Silver&Fit customer service at (877) 427-4711 (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m., local time, excluding holidays.

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina Medicare Complete Care (HMO-DSNP) H8845-007-001 and H8845-007-002

 

You receive a combined monthly allowance on a pre-funded debit card that may be used towards select supplemental plan benefits such as:

 

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

 

Please see the Pre-funded Debit Card (MyChoice Card) section for a complete list of benefit and services that are included in the combined allowance. Unused allowance does not carry over to next month.

 

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

 

To learn more about your benefits, see Chapter 4 of your Evidence of Coverage (see our Member Materials and Forms page).

 

Molina's Nurse Advice Line has highly trained nurses that can help you 24 hours a day, 365 days a year. They can help you decide what to do to get your family feeling better fast. A nurse can help you decide if you or your child should see a provider right away. There are times where you have questions, but you do not think you need to see your provider. We can look up health information from a trusted source and provide recommendations based on symptoms. Call the Nurse Advice Line. You can talk to a nurse in your language about any health problem. Our Nurse Advice Line receives more than 500,000 health advice calls from Molina Medicare members across the United States every year.

 

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: (800) 424-5891

 

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

 

Check your Member Materials and Forms to see all the standard benefits offered by Molina Medicare.