Molina Gold Core 1640 Plus with Adult Dental and Vision
Molina Healthcare of Utah, Inc.dba Molina Healthcare of Idaho · 2026 plan year
Gold
- Ind. deductible
- $1,640
- Family deductible
- $1,640
- Ind. OOP max
- $8,100
- Family OOP max
- $8,100
Compare with other Gold plans in ID
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Molina Healthcare of Utah, Inc.dba Molina Healthcare of Idaho plans in ID
Monthly premiums by age
Rating Area 4 — the lowest-priced of the 4 areas this plan covers. Premiums differ by area.
| Age | Individual |
|---|---|
| Under 15 | $318 |
| 21 | $415 |
| 30 | $471 |
| 40 | $531 |
| 50 | $742 |
| 60 | $1,127 |
| 64 and over | $1,246 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $25.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $55.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 25.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 25.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 25.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $40.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Non-Preferred Brand Drugs | 30.00% Coinsurance after deductible |
| Preferred Brand Drugs | $50.00 Copay after deductible |
| Specialty Drugs | 40.00% Coinsurance after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 25.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $25.00 |
Other
| Benefit | In-network |
|---|---|
| Accidental Dental | 25.00% Coinsurance after deductible |
| Allergy Testing | $25.00 |
| Basic Dental Care - Adult | 50.00% |
| Chemotherapy | 40.00% Coinsurance after deductible |
| Chiropractic Care | $25.00 |
| Delivery and All Inpatient Services for Maternity Care | 25.00% Coinsurance after deductible |
| Diabetes Education | No charge |
| Dialysis | $55.00 |
| Durable Medical Equipment | 25.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 25.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Habilitation Services | $25.00 |
| Home Health Care Services | 25.00% Coinsurance after deductible |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | 25.00% Coinsurance after deductible |
| Infusion Therapy | 25.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 25.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | $25.00 |
| Major Dental Care - Adult | 50.00% |
| Nutritional Counseling | No charge |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $25.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 25.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $25.00 |
| Prenatal and Postnatal Care | No charge |
| Prosthetic Devices | 25.00% Coinsurance after deductible |
| Radiation | 25.00% Coinsurance after deductible |
| Reconstructive Surgery | 25.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $25.00 |
| Rehabilitative Speech Therapy | $25.00 |
| Routine Dental Services (Adult) | No charge |
| Routine Eye Exam (Adult) | No charge |
| Routine Eye Exam for Children | No charge |
| Skilled Nursing Facility | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 25.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $25.00 |
| Transplant | 25.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 25.00% Coinsurance after deductible |
Service area
This plan covers 7 geographic areas.
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