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Molina Healthcare Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Nov 30, 2018

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California-based Molina Healthcare is an HMO offering a range of plans across several states. They not only offer health insurance but also run medical clinics as well offering managed care.

About Molina

Molina’s namesake, C. David Molina, worked as an emergency room physician in Long Beach, CA when he started his own medical clinic to help low-income patients receive access to care regardless of ability to pay. Founded in 1980, Molina grew over the years, and in 1997 expanded through acquisition into Utah and Michigan. Continued expansion brought the company into several other states. The company went public in 2003.

Molina offers Marketplace health plans, Medicare, and Medicaid options across most of its service area, although not all plans are offered in all states. Molina today is a Fortune 500 company and covers more than 3.5 million people. In keeping with their founder’s goal of helping low-income patients, many of the plans offered are in conjunction with state sponsored or federal programs.

Molina also participates in the marketplace, offering individual and family plans at all levels.

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Molina Health Plans

Molina’s plans vary from state to state, so for the purpose of this review, we will look at the plans offered in California, the company’s home state. Many of Molina’s California plans are connected with state or federal-run programs such as Medi-Cal, Medicaid, and Medicare.

Medi-Cal

Molina partners with the state of California to offer Medi-Cal coverage to low-income families. This plan is only available to those who qualify under state regulations.

The Medi-Cal plan covers a wide variety of healthcare needs including all preventative care, maternity care, hospital treatment, and even vision. Some coverage varies by county

Medicare and Medicaid

Molina offers their Medicare Options Plan to Medicare eligible members and the Plus plan for special needs patients who are eligible for both Medicare and Medicaid. Both plans are HMO-SNP plans that include prescription drugs.

These plans cover all medical care in addition to prescriptions, but hearing, dental, and vision are offered as supplemental coverage. As an HMO, in-network providers must handle all coverage, although out-of-network care may be authorized when required.

The Molina Dual Options Cal MediConnect plan is a specialized plan for those who qualify for both Medicare and Medicaid.

Marketplace Plans

Molina’s Covered California plans are marketplace health plans offering coverage within the HMO network.

The Minimum Coverage plan is a catastrophic plan that not all members will qualify for due to certain restrictions. This plan has a $7,150 individual and $14,300 family combined deductible for medical, prescriptions, and pediatric dental. All care is paid out of pocket until the deductible is met, at which point coverage kicks in at 100%.

There is one Bronze plan available, the Bronze 60, which has a $6,300 individual deductible and $12,600 family deductible. The prescription deductible is separate with $500 for individual and $1,000 for family, and prescriptions are covered at 100% after this deductible, up to $500 per prescription. Copays are $75 across the board for regular office visits and services.

Molina has four Silver plans:

Silver 94 has very low deductibles, at $75/$150 individual and family. Copays are very low at $5 for a primary care visit and $8 for a specialist visit. Prescriptions start at $3 for Tier 1 drugs. This is likely the most expensive of the Silver options.

Silver 87 has copays of $10 for primary care and $25 for specialists. The deductibles are $650 individual and $1,300 family. Prescriptions start at $5 for Tier 1 drugs.

Silver 73 has a $2,200 individual deductible and a $4,400 family deductible. Copays are $30 for primary care and $55 for specialist visits. Prescriptions start at $15 for Tier 1 drugs.

The Silver 70 plan has a $2,500 individual deductible and a $5,000 family deductible. Copays are $35 for primary and $70 for specialist visits. Like the previous plan, Tier 1 drugs are $15 with prices varying from there.

The Gold plan is the Molina Gold 80. This is a zero deductible plan with copays that match the Silver 73 plan at $30 and $55. Prescription drugs also have no deductible and start at $15.

The Platinum Plan is also a zero deductible plan. Primary care is covered with a $15 copay and specialist visits have a $40 co pay. Like the Gold plan, there is no prescription deductible, and drugs start at $5.

Rates

Molina does not appear to offer online quotes for their Medicare or Medi-Cal insurance products, however, there is a form that can be filled out in order to request information and rates. Quick quotes are available for marketplace plans.

We ran a quote in California for a single 30-year-old with an income of $50,000. The Bronze plan returned a rate of $173.18 per month and $227.49 for the Silver 70 plan. The Gold 80 plan came in at $255.00 and the Platinum Plan at $294.67. As our sample person qualifies for the catastrophic plan, we did return a quote of $173.14 for that option.

These rates appear to be reasonable, however, because health insurance costs can vary based on the person it is difficult to compare them even with a quote. The variety of options makes it increasingly difficult to create apples to apples comparisons across and even within companies.

Claims

As a healthcare company, Molina handles all claims directly and internally. Since they are an HMO, their billing departments will be connected to the providers directly, so there should rarely be an instance in which a member needs to handle a claim.

As we will see in the reviews of the company, there does seem to be some issues with Molina paying claims.

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Ratings and Consumer Reviews

Molina Healthcare in Long Beach has an F rating with the Better Business Bureau (BBB). This is due to the fact that, of 38 complaints filed in the past three years, they failed to respond to 29 and did not resolve two. While the number of complaints is not high, the failure to respond and resolve is certainly a surprising and concerning issue.

Pissed Consumer has 610 reviews of Molina, with an overall 2.8-star rating. The star rating is actually higher than we usually see, which means there are enough positive reviews to bring it up a bit. The total number of complaints is not terribly high for a company of this size, but taken with the F rating from the BBB, it does not paint a nice picture.

Many of the complaints cite denied claims, policy cancellations after automatic payment systems failed, frequent website down time, and difficulty with providers and delayed referrals.

While all health insurance companies have similar complaints, the overall image of this company is of one that is not responding to customer concerns, which raises red flags.

The Bottom Line

Molina is a very big company but seems to have somewhat moved away from its founder’s goal of putting patients before dollars. They have a good selection of plans at reasonable rates and may be helpful to those looking for help with state-run programs. Their reputation, however, is tarnished by a large number of similar complaints and failure to respond to and resolve problems.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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Molina Healthcare
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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

11 Comments

  1. So thankful for the reviews.

    I will NOT be going with Molina. I am sure I just avoided a lot of frustration.

    So thank you to all that did submit a review.

    Reply
  2. Absolutely horrible company to deal with! Been trying to get sinus medication for a week and they keep passing the buck. They are trying to say my doctor is not sending the proper paperwork to them. SURPRISE! I have copies of all the paperwork he has sent and he has met all of their requirements. Liar, Liar, Pants on fire !!! Another weekend with terrible headaches and chewing on Tylenol.

    Reply
  3. Worst insurance. I have called several offices from the list they provide of doctors who accept Molina. This list is completely outdated and when I brought this up to customer service they said it is up to the doctor to update this. That is ridiculous and clearly, it isn’t being updated by these doctors so it is up to YOU! What a waste of time it is having to call around to find a doctor in my network. On top of this, I cannot be seen by the doctor I have been assigned to (who has horrible reviews) for a month so I was told to go to urgent care. I asked for a list of urgent care’s that take Molina. They transferred me to a nurse hotline who then transferred me to another branch (I was lost at this point.) After being transferred I was told the nurse will have to call me back to go over urgent care’s. Why can’t I just have a list?? So, I was called back and given 2 choices for Urgent Care. Both are over an hour away from where I live. This is crazy. Maddening. This insurance is a joke and I am canceling ASAP.

    Reply
  4. This insurance company is crooked. I have Psoriasis, and they were nothing but a stumbling block to me getting my medications. They have lied to me several times. Molina lied on my dermatologist, blaming them for my treatments being denied when they flat out refused to cover the prescriptions. I have approved prior authorizations, but I can’t get my medication.

    Reply
  5. I have been trying to find a Molina doctor in my area (north of Houston). Every doctor I contact no longer accepts Molina, has never accepted it (and yes they are on the list sent me by Molina) or has been retired for years. Actually called one office and was told that yes the doctor takes Molina and their name was on the list and accepting new patients. Went to choose this doctor and a comment came up “this doctor is not available at this time”. Spoke to a representative and got the same runaround. Went to one doctor earlier this year, rude, incompetent, and I refuse to go back. Will not be renewing this insurance. I have never been so frustrated. THEY NEED TO UPDATE THEIR LIST!

    Reply
    • I’m in North West Florida and had the same issue with my child’s Pediatrician. I’m also running into this issue: the pediatric office is being remodeled, so they’re closed… and no other pediatricians in the tri-city area (within 1 hour from me) accept new Molina patients… so I’m left with Urgent Care. Only CVS Minute Clinics are available (covered with insurance) and they don’t accept patients as young as my son. So now I’m left with an Emergency Department… but none are covered through Molina… This company is a huge mess and they’re getting in the way of me taking care of my sick children.

      Reply
  6. I went with this company because the price seems reasonable, but DO NOT be fooled by that! The time I put in to call them about an unnecessary notice that they sent and errors they made is so NOT worth it! They screwed up in billing and terminated my kids’ plan! I had to pay cash to go see the doctor while they sorted it out. After all, they send a long list of things to do in order to get reimbursed!
    Some of the employees at the call center are so RUDE! This one woman named [Redacted] was so UNPLEASANT to talk to! DO NOT GO WITH THIS COMPANY!!!!!!! STAY AWAY FOR THE TROUBLE!!

    Reply
  7. Eric,
    You need to update your ratings on Molina because the physician who did such a great job is no longer with Molina. I read an investor’s guide report that said new administrators have mismanaged Molina. My experience as a former Molina customer is that they are not providing in-network physicians for some covered benefits in Orange County California. Molina has a list, but it’s outdated and Molina representatives called doctors offices for 3 months, but the company never authorized a doctor even though this was an urgent referral from my primary care physician. So I switched to Kaiser, which took care of me in the first few days. I filed a complaint with the California Department of Insurance and they quickly got back to me and assured me they would prosecute this, if necessary. I’m going through a lengthy appeal process with Molina. They offered to pay my claim right away if I signed a non-disclosure agreement. I’ll wait and get the word out to consumers. Californians can get help here: http://www.insurance.ca.gov/01-consumers/101-help/

    Reply
  8. My dad was in the hospital 3 times in the last two month. Molina Healthcare denied rehab 3 times.
    He had blood clots in his legs and his lungs. [Redacted] Hospital released him from the hospital with no oxygen or anything. We were back in less than 24 hours because he could not breathe at night. [Redacted] is about to release my dad from the hospital now without the oxygen because Molina Healthcare is denying payment for oxygen. Do not ever get Molina Healthcare, they decide if you get care or not.
    I’m looking for help to change my parents’ health insurance; so far I found no help. I’m still searching.

    Reply
  9. Molina HMO plans only covers birth control pills, but no other forms of birth control. The customer service agents will not tell you this when you call to ask what forms are covered, they do not have the correct information nor know how to correctly look it up. I don’t know how it is legal for them to do since it is stated in the ACA that all forms of birth control are covered, but any woman interested in any other form of birth control should look for another insurance provider.

    Reply
  10. Had Molina for a year and did not use it except for my annual check-up and yearly gynecological check-up and Pap. I made an appointment to see a gynecologist for the check-up and was instead seen and treated by a mid-wife. There was no sink in the examination room for the midwife to wash her hands and the front office staff did not seem to be trained for the most simple questions. My annual appointment fared no better with me having to go to a Community Health Care Clinic instead of a doctor’s office because there was none available in my area. Here again I was unable to see a doctor, and instead was seen by an ARNP. I was then sent an Explanation of Benefits letter from Molina with a charge for $11.64 under Total Patient Care Responsibility. After contacting Molina and asking about the charge, as this was my yearly free check-up, they told me it was a misprint on their part and just to ignore the charge. They refused to send a corrected Explanation of Benefits Letter so that I could be assured that I would have no financial responsibility to them. I did not use Molina Insurance for anything except these two free annual check-ups. I have cancelled this insurance for the next year and will find other health care insurance.

    Reply

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