Molina Silver Saver 94 with Four Free PCP Visits

Molina Healthcare of Utah, Inc.dba Molina Healthcare of Idaho · 2027 plan year

Silver
Ind. deductible
$300
Family deductible
$600
Ind. OOP max
$2,200
Family OOP max
$4,400

More Molina Healthcare of Utah, Inc.dba Molina Healthcare of Idaho plans in ID

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$3.00

Specialist

BenefitIn-network
Specialist Visit$6.00

Hospital

BenefitIn-network
Emergency Room Services25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services25.00% Coinsurance after deductible
Urgent Care Centers or Facilities$20.00

Pharmacy

BenefitIn-network
Generic Drugs$3.00
Non-Preferred Brand Drugs30.00% Coinsurance after deductible
Preferred Brand Drugs$20.00
Specialty Drugs40.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$3.00

Other

BenefitIn-network
Accidental Dental25.00% Coinsurance after deductible
Allergy Testing$3.00
Chemotherapy40.00% Coinsurance after deductible
Chiropractic Care25.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care25.00% Coinsurance after deductible
Diabetes EducationNo charge
Dialysis$6.00
Durable Medical Equipment25.00% Coinsurance after deductible
Emergency Transportation/Ambulance25.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services25.00% Coinsurance after deductible
Home Health Care Services25.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)25.00% Coinsurance after deductible
Infusion Therapy25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
Nutritional CounselingNo charge
Other Practitioner Office Visit (Nurse, Physician Assistant)$3.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)25.00% Coinsurance after deductible
Outpatient Rehabilitation Services25.00% Coinsurance after deductible
Prenatal and Postnatal CareNo charge
Prosthetic Devices25.00% Coinsurance after deductible
Radiation25.00% Coinsurance after deductible
Reconstructive Surgery25.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy25.00% Coinsurance after deductible
Rehabilitative Speech Therapy25.00% Coinsurance after deductible
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility25.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services25.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$3.00
Transplant25.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible

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