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Silver 1

42326SC0010002
Silver
HMO

Silver 1 is a Silver HMO plan by Molina Healthcare.

IMPORTANT: You are viewing the 2024 version of Silver 1 42326SC0010002. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

Silver 1 is offered in the following counties.

Plan Overview

This is a plan overview for 2024 version of Silver 1 42326SC0010002.
Insurer: Molina Healthcare
Network Type: HMO
Metal Type: Silver
HSA Eligible?: No
Plan ID: 42326SC0010002

Cost-Sharing Overview

Silver 1 offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Silver 1?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Silver 1 offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Heart Disease, Depression, Diabetes, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Silver 1 covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: No
Out of Service Area Coverage Description:
National Network: No

Additional Benefits and Cost-Sharing

Silver 1 includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Specialist Visit
Covered
$60.00 Not ApplicableNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Hospice Services
Covered
No Charge Not ApplicableNot Applicable 100.00%
Routine Dental Services (Adult)
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Routine Eye Exam (Adult)
Urgent Care Centers or Facilities
Covered
$45.00 Not ApplicableNot Applicable 100.00%
Home Health Care Services
Covered
No Charge Not ApplicableNot Applicable 100.00%60.0 Visit(s) per Benefit Period
Emergency Room Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 35.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 35.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Bariatric Surgery
Cosmetic Surgery
Skilled Nursing Facility
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%60.0 Days per Benefit Period
Prenatal and Postnatal Care
Covered
No Charge Not ApplicableNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00% Separate cost-sharing may apply for professional services.
Mental/Behavioral Health Outpatient Services
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Generic Drugs
Covered
$29.00 Not ApplicableNot Applicable 100.00%
Preferred Brand Drugs
Covered
$65.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Specialty Drugs
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Habilitation Services
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Chiropractic Care
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Durable Medical Equipment
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge Not ApplicableNot Applicable 100.00% Mammography services, OBGYN exams, pap smear services, prostate services, and routine colorectal cancer screening/testing.
Routine Foot Care
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
No Charge Not ApplicableNot Applicable 100.00%1.0 Exam(s) per Benefit Period
Eye Glasses for Children
Covered
No Charge Not ApplicableNot Applicable 100.00%1.0 Item(s) per Benefit Period
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$30.00 Not ApplicableNot Applicable 100.00%30.0 Visit(s) per Benefit Period Physical Therapy, Occupational Therapy and Speech Therapy are limited to a 30-visit limit per therapy per year.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$30.00 Not ApplicableNot Applicable 100.00%30.0 Visit(s) per Benefit Period Physical Therapy, Occupational Therapy and Speech Therapy are limited to a 30-visit limit per therapy per year.
Well Baby Visits and Care
Covered
No Charge Not ApplicableNot Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
$60.00 Not ApplicableNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
$95.00 Not ApplicableNot Applicable 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Abortion for Which Public Funding is Prohibited
Transplant
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Accidental Dental
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Dialysis
Covered
$60.00 Not ApplicableNot Applicable 100.00%
Allergy Testing
Covered
$30.00 Not ApplicableNot Applicable 100.00%
Chemotherapy
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Radiation
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Diabetes Education
Covered
No Charge Not ApplicableNot Applicable 100.00% Diabetes self-management training and education will be provided on an outpatient basis when done by a registered or licensed health care professional that is certified in diabetes.
Prosthetic Devices
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Infusion Therapy
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Covered
No Charge Not ApplicableNot Applicable 100.00%
Reconstructive Surgery
Covered
Not Applicable 35.00% Coinsurance after deductibleNot Applicable 100.00% Reconstructive Surgery that is considered a Covered Expense is limited to Surgery: To correct a functional defect that results from a birth defect, disease and anomaly; or Performed to correct a seriously disfiguring condition resulting from injury; or For breast reconstruction after a mastectomy.
Gender Affirming Care

Free Preventive Services

There is no copayment or coinsurance for any of the following Silver 1 preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Silver 1 including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Silver 1?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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