Molina Healthcare Review

Molina Healthcare Insurance Review

Molina Healthcare is a major provider of government-sponsored health coverage, including Medicaid, CHIP, ACA Marketplace plans, and Medicare Advantage. As of 2026, it operates in over 15 states and Puerto Rico, with continued growth in the dual-eligible (Medicare + Medicaid) market. Molina is known for affordability and integrated care, but faces persistent customer service challenges and quality concerns.

Pros and Cons

Pros

• Low-cost ACA and Medicare Advantage plans with $0 premium options
• Strong Medicaid presence and CHIP coverage across multiple states
• Expanding dual-eligible Medicare-Medicaid plans (MMPs and D-SNPs)
• Dental, vision, OTC, and wellness benefits included in many plans
• Care coordination and social determinant initiatives in some areas

Cons

• No PPO, Medigap, short-term, or student plans
• Limited employer coverage and narrow provider networks
• Below-average CMS and NCQA quality ratings
• Higher-than-average complaint rates, especially billing and service-related
• Not available in all U.S. states; lacks global or national portability

Coverage Area (2026)

United States

Operates in at least 15 states, including California, Florida, Illinois, Michigan, Ohio, New Mexico, New York, South Carolina, Texas, Utah, Washington, Wisconsin, and Puerto Rico. Expansion efforts include Georgia, Idaho, and Massachusetts. Coverage remains regional.

International

No international plan offerings. Emergency care abroad may be limited and is not standard.

Provider Network

Molina primarily uses HMO networks, which may restrict access to out-of-network providers. Networks vary by state.

Plan Types Offered (2026)

Under-65 (Individual & Family)

• ACA Marketplace Plans
  This carrier offers ACA health plans available in 15 states with low premiums and deductibles. Plans are HMO-based.
• Short-Term Medical (STM)
  Not offered.
• Employer-Sponsored Plans
  Very limited availability; focus remains on government programs.
• Student Health Plans
  Not available.
• Medicaid
  Includes Extensive Medicaid contracts with state governments for TANF, CHIP, and ABD services. View Molina Medicaid Service Areas.

Medicare (65+)

• Medicare Advantage (MA)
  Molina offers Medicare Advantage Plans (Part C) in 15+ states with $0 premium HMO plans and prescription drug coverage. Focus on Dual-Eligible Special Needs Plans (D-SNPs).
• Medicare Supplement (Medigap)
  Not offered.
• Part D Prescription Drug Plans
  Included in most MA plans; standalone Part D plans are not available.
• Medicare-Medicaid Plans (MMPs)
  Integrated plans for dual-eligibles are offered in states like Illinois and California. See their latest expansion growth announcement.
• Retiree Group Medicare
  Not publicly offered.

Recent Changes in Cost and Options (2026)

Premiums and Rate Changes

Molina continues to lead in ACA affordability, with average individual premiums around $395/month. Medicare Advantage plans remain at $0 premiums in many markets.

Out-of-Pocket Costs

Low deductibles (e.g., $2,542 on average for ACA) and reduced MOOP caps for Medicare Advantage (as low as $6,000 in some areas).

Medicare Advantage Updates

This year, Supplemental benefits have been updated, including new vendors for hearing, meal delivery, and OTC.

Plan Enhancements

Continued focus on doula programs, wellness incentives, and social health needs.

Network Agreements

Network changes are ongoing; plans remain HMO-based with limited flexibility.

Consumer Experience Snapshot

Complaint Index:

Molina receives more complaints than average, especially around customer service, billing, and network restrictions.

Satisfaction Scores:

CMS Medicare Advantage average star rating: 3.0/5. NCQA plan scores typically range from 2.0 to 3.0/5.

Methodology

Our Health Insurance Rating Methodology scores insurers across five main categories, each rated on a scale of 1 to 10. The overall score is the average of: Coverage, Breadth and Accessibility, Plan Variety and Customization, Affordability and Value, Innovation and Care Quality, and Consumer Experience and Transparency. Categories assess provider reach, plan diversity, cost structure, care delivery, and member service experiences based on public data, filings, and expert analysis.

Bottom Line

Molina Healthcare is a top choice for cost-conscious Medicaid and ACA enrollees, especially dual-eligible members needing Medicare and Medicaid integration. With low premiums, reduced out-of-pocket costs, and expanding state contracts, Molina delivers affordability. However, limited plan variety, weak satisfaction scores, and regional restrictions make it less suitable for those seeking broader access or enhanced service quality.

Best for

Low-income individuals and dual-eligible members seeking ACA, Medicaid, or Medicare Advantage coverage.

Not ideal for

People needing PPO or Medigap plans, national flexibility, or high-touch customer support.

Disclaimer

The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.