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 place to get it.

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UPDATED: Sep 15, 2020

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Molina Healthcare

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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.

Table of Contents

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.

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