Molina Silver Saver

Molina Healthcare

Silver

Ind. deductible: $7,000
Family deductible: $7,000
Ind. OOP max: $10,150
Family OOP max: $10,150

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Zero Cost Sharing Plan Variation

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$448	—
30	$508	—
40	$572	—
50	$800	—
60	$1,215	—

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	$3.00

Specialist

Benefit	In-network
Specialist Visit	$62.50

Hospital

Benefit	In-network
Emergency Room Services	20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	20.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	0.00%
Urgent Care Centers or Facilities	$60.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Non-Preferred Brand Drugs	20.00% Coinsurance after deductible
Preferred Brand Drugs	$50.00
Specialty Drugs	20.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	20.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$10.00

Other

Benefit	In-network
Accidental Dental	20.00% Coinsurance after deductible
Acupuncture	Not covered
Abortion for Which Public Funding is Prohibited	Not covered
Orthodontia - Child	Not covered
Allergy Testing	$40.00
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	20.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	20.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Education	No charge
Dialysis	$62.50
Durable Medical Equipment	20.00% Coinsurance after deductible
Emergency Transportation/Ambulance	20.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	20.00% Coinsurance after deductible
Hearing Aids	Not covered
Home Health Care Services	20.00% Coinsurance after deductible
Hospice Services	No charge
Imaging (CT/PET Scans, MRIs)	20.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	20.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	20.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	No charge
Orthodontia - Adult	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$40.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	20.00% Coinsurance after deductible
Outpatient Rehabilitation Services	0.00%
Prenatal and Postnatal Care	No charge
Private-Duty Nursing	Not covered
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	0.00%
Reconstructive Surgery	20.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	20.00% Coinsurance after deductible
Rehabilitative Speech Therapy	0.00%
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	20.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$3.00
Transplant	20.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	Not covered
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	20.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 37 geographic areas.