Molina Healthcare offers four types of government-sponsored health insurance: Medicaid (including the Children’s Health Insurance Program), individual plans sold through the ACA Marketplace, Medicare Advantage, and Dual Eligible Special Needs Plans for people who qualify for both Medicare and Medicaid. All of them are HMOs, and all of them are sold in a limited set of states rather than nationwide. Molina does not sell employer group coverage, standalone dental, or Medicare Supplement (Medigap) policies.
Medicaid
Medicaid is Molina’s core business. The company contracts with state Medicaid agencies to manage care for enrollees, providing doctor visits, hospital stays, prescriptions, and preventive care through a network of participating providers. Because each state runs its own Medicaid program within federal guidelines, what Molina covers and who qualifies depends on where you live.
Eligibility hinges on income measured against the Federal Poverty Level. In states that have expanded Medicaid under the ACA, adults earning up to 138% of the poverty level generally qualify. In states that haven’t expanded, eligibility is narrower and often limited to pregnant women, children, and people with disabilities. Molina works with state agencies to verify income and household size during enrollment.
Preventive services like vaccinations and screenings are covered at no cost. Other cost-sharing is limited by federal regulation, though states can impose small copays for things like non-emergency ER visits or brand-name drugs.1eCFR. 42 CFR 447.52 – Cost Sharing
One change to be aware of: starting October 1, 2026, federal law narrows which categories of lawfully present immigrants qualify for Medicaid, restricting eligibility mainly to green card holders, Cuban and Haitian entrants, and citizens of Compact of Free Association nations. That will affect Molina enrollees in every state where the company operates.
CHIP
Molina administers CHIP plans in several states.2Molina Healthcare. CHIP CHIP covers children whose family income is too high for Medicaid but too low to comfortably afford private insurance. States set their own CHIP income limits, which often reach 200% to 300% of the poverty level. Coverage looks a lot like Medicaid — doctor visits, hospital care, prescriptions, dental, and vision — with low or no premiums and minimal copays.
ACA Marketplace Plans
Molina sells individual health insurance through the ACA Marketplace, the federally run platform where people who don’t have employer coverage or qualify for Medicaid can shop for plans.3Centers for Medicare & Medicaid Services. Overview of the Exchanges Plans are grouped into Bronze, Silver, Gold, and Platinum tiers based on how costs split between insurer and enrollee. A Bronze plan covers about 60% of expected medical costs; Platinum covers roughly 90%. Molina’s Marketplace offerings lean toward Silver and Gold.
For 2026, premium tax credits are available to households earning between 100% and 400% of the Federal Poverty Level. The enhanced subsidies that temporarily removed the 400% income cap from 2021 through 2025 were not extended, so higher-income enrollees who previously received help now face the full premium. Households earning up to 250% of the poverty level can also get cost-sharing reductions (lower deductibles and copays), but only if they choose a Silver plan.
All Marketplace plans, Molina’s included, must cover ten categories of essential health benefits: outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services, lab work, preventive care, and pediatric services including dental and vision.4Office of the Law Revision Counsel. 42 USC 18022 – Essential Health Benefits Requirements Annual out-of-pocket spending is capped at $10,600 for individuals and $21,200 for families in 2026.
Because Molina runs its Marketplace plans as HMOs, you pick a primary care physician from Molina’s network, and that doctor manages referrals to specialists. Out-of-network care generally isn’t covered except in emergencies. Check the provider directory before enrolling.
Medicare Advantage
Molina offers Medicare Advantage (Part C) plans, which bundle hospital coverage (Part A) and medical coverage (Part B) into a single plan administered by Molina instead of the federal government.5HHS.gov. What Is Medicare Part C Most of Molina’s Medicare Advantage plans also include prescription drug coverage (Part D), so a separate drug plan isn’t required.6Medicare.gov. Understanding Medicare Advantage Plans
The pitch over Original Medicare is the extras. Molina’s plans frequently include dental, vision, and hearing benefits that Original Medicare doesn’t cover, plus perks like transportation to medical appointments and over-the-counter medication allowances. The tradeoff is the network: Molina’s Medicare Advantage plans are HMOs, so you need to use in-network providers and get referrals for specialists.
One cost that surprises people: you still pay your Medicare Part B premium on top of any Molina plan premium. For 2026, the standard Part B premium is $202.90 per month, with higher-income enrollees paying more under income-related adjustment brackets.7Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles Unlike Original Medicare, Medicare Advantage plans cap your total annual out-of-pocket spending.
Dual Eligible Special Needs Plans (D-SNPs)
Molina offers D-SNPs for people who qualify for both Medicare and Medicaid at the same time. These plans coordinate benefits from both programs under a single insurer, which simplifies what would otherwise be a confusing tangle of two separate systems.8Molina Healthcare. Molina Medicare Model of Care – Provider Training 2026 Providers coordinate Medicare and Medicaid benefits together, including long-term services, behavioral health, and home- and community-based care.
The financial benefit is significant. In many cases Medicaid picks up the cost-sharing that Medicare normally requires, leaving $0 copays for doctor visits, hospital stays, and specialist care. Molina’s 2026 D-SNP in California, for instance, charges $0 monthly premiums, $0 deductibles, and $0 copays for most services. That plan also includes a $350 eyewear allowance, up to two hearing aids every two years, a $102 monthly over-the-counter allowance, and 12 one-way trips per year for medical transportation.9Molina Healthcare. 2026 Summary of Benefits – Molina Medicare Complete Care HMO DSNP Members meeting certain chronic illness criteria can also receive a $175 monthly food and produce allowance on a preloaded debit card.
To join a Molina D-SNP, you must be entitled to Medicare Part A, enrolled in Part B, and have active Medicaid coverage through your state. Benefits vary because each D-SNP operates under a contract between Molina and the state Medicaid agency.
Where Molina Sells Coverage
Molina does not operate nationwide. As of 2026, the company serves members in roughly 20 states, including Arizona, California, Florida, Georgia, Idaho, Illinois, Iowa, Kentucky, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin.10Molina Healthcare. Where Are We on the Map Not every product is available in every state. Molina might sell Medicaid in one state but not Marketplace plans, or the reverse. Confirm current availability in your county through Molina’s website or your state’s Medicaid agency before assuming a product is offered where you live.
Network size also varies by state and even by county. Some areas have broad provider choices; others are thinner, particularly for specialists. Because all Molina plans are HMOs, checking the provider directory to confirm your preferred doctors and hospitals participate is the single most important step before you enroll.
When You Can Enroll
Enrollment windows depend on which Molina product you’re after.
- Medicaid and CHIP: apply any time of year. Coverage can begin almost immediately depending on how quickly your state processes the application.
- ACA Marketplace: open enrollment runs November 1 through January 15. To have coverage start January 1, enroll by December 15. Outside that window you need a qualifying life event to enroll or switch.11HealthCare.gov. When Can You Get Health Insurance
- Medicare Advantage: the Annual Election Period runs October 15 through December 7 for coverage starting January 1. If you’re already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 through March 31 lets you switch plans or return to Original Medicare.
- D-SNPs: dual-eligible individuals can typically enroll in or switch D-SNPs quarterly through Special Enrollment Periods tied to their Medicaid status.
Missing these windows can leave you uninsured for months, particularly on the Marketplace side. A calendar reminder for early November is cheap insurance against that mistake.