Molina Medicare Advantage Plans 2025

Are you evaluating the Medicare Advantage plans 2025? This straight-to-the-point analysis unpacks the impact of the latest healthcare regulations on your benefits and costs, revealing what to anticipate in terms of coverage, premiums, and exclusive advantages unique to the Molina plans.


Key Takeaways

  • Molina Medicare Advantage plans in 2025 are expected to receive increased overall payments despite CMS’s proposed rate reduction, potentially leading to premium adjustments balancing higher medical utilization costs against beneficiary access to enhanced benefits.


  • MA plans must conduct annual health equity analyses and inform beneficiaries about unused benefits, with Molina focusing on providing Special Supplemental Benefits for the Chronically Ill (SSBCI) to ensure the chronically ill receive improved health outcomes.


  • Molina’s MA plans are adapting to state-specific healthcare regulations, with California requiring coverage at least equivalent to Original Medicare, and New York’s competitive market necessitating plan alignment with local preferences and strong consumer protections.

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Navigating Changes in Molina Medicare Advantage Plans for 2025


Molina Medicare Advantage Plans 2025 Navigating Changes in Molina Medicare Advantage Plans for 2025


Although the Centers for Medicare & Medicaid Services (CMS) have suggested a 0.2% rate reduction, Molina’s MA plans are set to receive a whopping $16 billion more in overall payments compared to the previous year. This windfall of increased payments is poised to fuel significant changes in Molina’s MA plans, set against the backdrop of rising medical utilization among seniors, which could potentially impact premium costs and benefits.


Premium Adjustments and Their Impact

Regulatory changes and an uptick in medical utilization have led insurers, including major Medicare Advantage providers like UnitedHealth and Humana, to contemplate the reduction of benefits or premium hikes. This could potentially sway premium adjustments in Molina’s MA plans for 2025. Even with these potential changes, the CMS has reiterated its commitment to uphold stability in premiums and benefits. This indicates that 2025 may still see Molina’s MA plans offering enhanced benefits.

The rising medical utilization among seniors, which is expected to persist into 2025, could also influence the adjustments in Molina’s MA plan premiums. This trend could potentially lead to an increase in premiums or a reduction in benefits as insurers grapple with the increased costs of healthcare provision. Nonetheless, beneficiaries can be reassured by the CMS’s emphasis on stability in spite of rate changes, signaling that enhanced benefits from their MA plans in 2025 are still plausible.


Enhanced Benefits on the Horizon

In 2025, MA plans like Molina’s will be required to conduct annual health equity analyses of their prior authorization policies and procedures. This heightened focus on health equity demonstrates the increasing commitment of Molina and other insurers to create a more balanced and fair healthcare landscape.

Additionally, the introduction of the ‘Mid-Year Enrollee Notification of Unused Supplemental Benefits’ policy ensures that Medicare Advantage enrollees are informed about unused benefits, including those addressing food insecurity and inadequate transportation.

Keeping pace with the push to improve health outcomes for those with chronic illnesses, Molina must ensure the effectiveness of Special Supplemental Benefits for the Chronically Ill (SSBCI). These benefits must now be backed by research with the expectation of improving health outcomes for the chronically ill. This shift in approach represents a significant enhancement in benefits, particularly for those dealing with chronic health conditions.


Network Expansion and Provider Partnerships

As the seventh-largest provider of for-profit Medicare Advantage plans, Molina Healthcare offers these plans in 14 states. The increasing popularity of Medicare Advantage, with over half of all Medicare beneficiaries enrolled, suggests that Molina and other insurers are likely to expand their network presence and provider partnerships for 2025. This expansion would translate into a wider range of healthcare options for beneficiaries, thus bolstering their access to quality care.

However, increased network presence comes with a caveat for members. To avoid incurring additional out-of-network charges, it’s crucial for members to ensure their preferred medical providers are included in Molina’s plan network. This implies that members must exercise due diligence to fully utilize the benefits brought by Molina’s network expansion.


Emphasizing Health Equity in 2025’s MA Plans


Molina Medicare Advantage Plans 2025 Emphasizing Health Equity in 2025's MA Plans


One of the significant shifts in Molina’s 2025 MA plans is the emphasis on health equity. The Medicare Advantage Value-Based Insurance Design (VBID) Model, which includes 69 participating Medicare Advantage Organizations with 12.4 million enrollees projected to be enrolled in participating plan benefit packages, provides supplemental benefits tailored to patients’ needs, such as lower prescription drug costs, grocery assistance, transportation services, and support for managing chronic health conditions.


Addressing Social Determinants of Health

The VBID Model aims to:

  • Test a wide spectrum of health plan innovations to improve the quality of care for enrollees, particularly those with lower incomes


  • Strive to reduce costs for both the enrollees and the overall Medicare program


  • Emphasize addressing social determinants of health to achieve health equity and ensure comprehensive care for all beneficiaries.


Enrollment in Special Needs Plans (SNPs) has doubled since 2018, reflecting a growing segment that could significantly impact the design of California’s Medicare Advantage plan offerings. These SNPs are specifically designed to cater to the unique needs of beneficiaries with specific diseases or characteristics, thereby ensuring that care is tailored to the individual’s needs.

This increase in SNP enrollment underscores the growing recognition of the need to address social determinants of health in Medicare Advantage plans.


Culturally Competent Care Initiatives

Culturally competent care is vital for meeting the healthcare needs of diverse populations. Recognizing this, Molina may offer culturally tailored Medicare Advantage plans in California due to the state’s significant Hispanic and Asian populations. These tailored plans may include language support and benefits designed to address the specific health needs of these communities, thereby providing care that is not only high quality but also sensitive to cultural nuances.

Besides the current culturally competent care initiatives, the 2025 VBID Model will include flexibilities for targeted enrollees to receive primarily and non-primarily health-related supplemental benefits, which can enhance the cultural appropriateness of care. The VBID Model aims to improve health outcomes by addressing social and other factors as part of a person-centered approach to care, which includes considerations for cultural competence in care delivery.

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The Role of State-Specific Changes: California and New York


Molina Medicare Advantage Plans 2025 The Role of State-Specific Changes: California and New York


Medicare Advantage plans are significantly shaped by state-specific regulations and market dynamics. In this section, we’ll explore how these factors influence Molina’s MA plans in California and New York – two states with unique healthcare landscapes.


California’s Unique Market Dynamics

In California, regulations mandate that Medicare Advantage plans must provide coverage at least equivalent to Original Medicare, significantly influencing the design of Molina’s MA plans in the state. The California Department of Managed Health Care (DMHC) oversees the regulation of health plans in the state, ensuring that they abide by state consumer protection laws.

The growth in Medicare Advantage plan offerings in California is shaped by the market’s attractiveness to insurers, with new firms entering the market and expanding choices for beneficiaries. This expansion of choice is crucial for beneficiaries as it allows them to select a plan that best meets their healthcare needs.

The increasing prevalence of extra benefits like dental, vision, and hearing, often at no additional premium, is a key factor in the competitiveness of Medicare Advantage plans in California.


New York’s Approach to Medicare Advantage

In New York, Molina’s Medicare Advantage plans operate in a highly competitive market dominated by insurers like UnitedHealthcare and Humana, each with significant market shares. This competitive landscape necessitates that Molina’s MA plans in New York align with local market conditions and consumer preferences to remain competitive.

In addition, the state’s insurance market presents unique aspects such as strong Medigap consumer protections and a wide range of Medicare Part D plans, which could influence beneficiary perceptions towards Medicare Advantage plans provided by Molina.

The proposal to redefine “compensation” for agents and brokers, with a national fixed compensation amount, aims to create incentives for enrolling individuals in the Medicare Advantage plan that best meets their needs. This could potentially affect how Molina’s plans are marketed in New York.


Understanding Enrollment and Eligibility

It’s important to comprehend the key enrollment periods, deadlines, and eligibility requirements to fully benefit from Molina’s MA plans. In this section, we’ll unravel these details to help potential beneficiaries navigate the enrollment process with ease.


Key Enrollment Periods and Deadlines

The Initial Enrollment Period for Medicare Advantage plans starts 3 months before an individual gets Medicare and ends 3 months after they get Medicare. During this period, a new Medicare beneficiary can join any Medicare Advantage Plan, and coverage start times vary based on when the enrollment request is processed.

In addition to the Initial Enrollment Period, there are several other key periods where changes to MA plans can be made. For instance, the annual Open Enrollment Period for Medicare Advantage, which runs from October 15 to December 7, allows current plan members to switch plans or switch back to Original Medicare.

This crucial date in the Medicare calendar ensures that beneficiaries have the opportunity to review and adjust their coverage as needed.

Special Enrollment Periods allow for changes to Medicare Advantage Plans outside of regular enrollment periods, occasioned by specific events.


Eligibility Requirements and Considerations

To be eligible for Molina Medicare Advantage plans, an individual must be enrolled in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). In addition, the individual must reside within the service area of the Molina Medicare Advantage plan they wish to join.

Those with Medicare Supplement Insurance (Medigap) cannot enroll in Medicare Advantage plans; Medigap policies do not work with Medicare Advantage.

Eligibility for Medicare, and subsequently for Molina Medicare Advantage Plans, typically starts at age 65 for U.S. citizens or legal permanent residents of at least five consecutive years. However, people under 65 may also be eligible if they meet specific disability criteria, such as having received disability benefits for at least two years or if they have a diagnosis of end-stage renal disease or ALS.

Financial Aspects: Costs and Savings with Molina MA Plans


Molina Medicare Advantage Plans 2025 Financial Aspects: Costs and Savings with Molina MA Plans


A look at the financial aspects of Molina’s MA plans reveals their affordability in terms of baseline costs, potential Part B premium refunds, and varying out-of-pocket costs.

This section will provide a comprehensive understanding of these cost aspects, providing a comprehensive understanding of the potential financial implications of joining a Molina MA plan.


Analyzing Plan Costs and Member Payments

Joining a Molina Medicare Advantage (MA) plan involves various costs such as:

  • Plan premiums


  • Yearly deductibles


  • Copayments


  • Coinsurance for medical services


These costs can vary based on the member’s geographic location and individual health needs. However, Molina’s MA plans define in-network and out-of-network out-of-pocket maximums, outlining the maximum amount members pay for covered services within a plan year.

Members should pay attention to the following factors when considering a plan:

  • The cost of extra benefits provided by the plan. While these extra benefits provide added value, they come at a cost that members need to account for in their budgeting.


  • Whether their providers are in-network. This is important to avoid additional charges.


  • The cost of any extra benefits provided by the plan.


By considering these factors and obtaining the necessary permission, members can make an informed decision about which plan, and its associated contracts, is best for them.


Ways to Maximize Savings on Healthcare Expenses

Opting for a plan that covers a portion of the Medicare Part B premium could result in direct savings for members of Molina MA plans. For instance, if a member is typically responsible for the Medicare Part B premium, which is $174.70 per month, a plan that covers part or all of this cost can significantly reduce the member’s out-of-pocket expenses.

Moreover, plans that offer extra benefits, like fitness memberships, transportation benefits, or meal delivery, provide additional value and can lead to potential savings for members. These extra benefits offer not just health benefits but also financial ones, making them an essential consideration when choosing an MA plan.


Leveraging Technology and Support Services

In the current digital era, technology has a significant part in managing healthcare. Molina’s MA plans to leverage technology to provide user-friendly digital tools and improved customer support services, making it easier for members to manage their health needs.


Digital Tools for Members

Molina’s MA plans provide a user-friendly digital platform that enables members to monitor their health records, manage appointments, and access plan information. This online access simplifies healthcare management, allowing members to navigate their health needs at any time.


Customer Support and Guidance

Molina’s MA plans emphasize the provision of robust customer support. Members have access to a variety of resources, including a call center for answering inquiries related to benefits and claims processing. Healthcare navigators guide members through the intricacies of their benefit options and assist with medical claims.

In addition to these resources, Molina’s customer service includes:

  • Personalized guidance to help members make informed healthcare choices based on their medical needs and plan benefits


  • Support representatives who are trained to assist with understanding the usage of plan features, such as pharmacy benefits and specialist referrals


  • Recent enhancements, including the addition of more representatives and extended hours, leading to improved member satisfaction.



As we’ve seen, the year 2025 promises significant changes in Molina Medicare Advantage plans, with an expected increase in overall payments, potential premium adjustments, and enhanced benefits. The emphasis on health equity, the introduction of culturally competent care initiatives, the expansion of network presence, and the leveraging of technology are all set to reshape the healthcare experience for seniors.

As we navigate the evolving landscape of Medicare Advantage, one thing is clear: Molina is committed to providing quality, affordable, and accessible healthcare for all its members.

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Frequently Asked Questions


What is the maximum out-of-pocket for Medicare Advantage plans in 2023?

In 2023, the maximum out-of-pocket for Medicare Advantage plans is $4,835 for in-network expenses and $8,659 for combined in-network and out-of-network expenses.


Is Medicare premiums going down in 2024?

The standard monthly Medicare Part B premium will be $174.70 in 2024, which is an increase of $9.80 from 2023. Additionally, the annual deductible for all Medicare Part B enrollees in 2024 will be $240, an increase of $14 from 2023.


What are the rates for Medicare Advantage in 2024?

The estimated average monthly Medicare Advantage plan premium for 2024 is $18.50, but costs may vary based on the insurer and level of coverage. Some plans offer $0 premiums, while others have premiums of $200 or more.


What are the proposed changes in Molina Medicare Advantage Plans for 2025?

In 2025, the proposed changes in Molina Medicare Advantage Plans include potential premium adjustments and enhanced benefits, despite a 0.2% rate reduction. These adjustments are fueled by a $16 billion increase in overall payments.


How will the Medicare Advantage Value-Based Insurance Design (VBID) Model impact Molina’s MA plans in 2025?

The VBID Model will impact Molina’s MA plans by addressing social determinants of health and providing culturally competent care, tailored to patients’ needs. It will also encourage the use of Part D prescription drug benefits.

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