Molina Healthcare stands as a prominent provider specializing in government-funded health insurance programs, including Medicaid, CHIP, ACA Marketplace plans, and Medicare Advantage. Operating across more than 15 states and Puerto Rico as of 2026, Molina continues to expand its reach, particularly in serving dual-eligible populations that qualify for both Medicare and Medicaid. Known for offering affordable coverage options and integrated care solutions, Molina aims to meet the health needs of underserved communities. However, like many insurers, it faces ongoing challenges related to customer service quality and provider network limitations. This review provides an in-depth look at Molina’s offerings, strengths, weaknesses, and how it compares within the broader health insurance landscape.

Pros and Cons

Pros

  • Offers budget-friendly ACA plans and Medicare Advantage options with some plans featuring $0 premiums, making healthcare more accessible for low-income families.
  • Maintains a strong Medicaid footprint and CHIP coverage in multiple states, supporting children and families with essential health services.
  • Expanding its portfolio of dual-eligible plans, including Medicare-Medicaid Plans (MMPs) and D-SNPs, which streamline benefits for those qualifying for both programs.
  • Many plans come with added benefits such as dental, vision, over-the-counter (OTC) supplies, and wellness programs, enhancing overall member health.
  • Implements initiatives focused on care coordination and addressing social determinants of health, aiming to improve outcomes for vulnerable populations.

Cons

  • Does not offer certain plan types like Preferred Provider Organization (PPO), Medigap supplemental plans, short-term health plans, or student-specific coverage.
  • Limited employer-sponsored plans and narrow provider networks can restrict access to preferred healthcare providers, especially outside of HMO arrangements.
  • Quality ratings from CMS and NCQA tend to be below industry averages, indicating room for improvement in care delivery and member satisfaction.
  • Reports indicate higher-than-average complaint rates, particularly concerning billing issues and customer service experiences.
  • Coverage remains regional, with no international plans or global portability, which can be a drawback for frequent travelers or those seeking nationwide coverage.

Coverage Area (2026)

United States

Molina Healthcare operates primarily in at least 15 states, including California, Florida, Illinois, Michigan, Ohio, New Mexico, New York, South Carolina, Texas, Utah, Washington, Wisconsin, and Puerto Rico. The company is actively expanding into additional markets such as Georgia, Idaho, and Massachusetts, although its coverage remains regional and not nationwide.

International

Currently, Molina does not offer international health plans. Emergency care abroad may be limited and is not a standard benefit within its plans.

Provider Network

The insurer predominantly utilizes HMO networks, which can restrict access to out-of-network providers. Network size and availability vary significantly by state, potentially impacting member choice and flexibility.

Plan Types Offered (2026)

Under-65 (Individual & Family)

  • ACA Marketplace Plans

Offers affordable, low-premium, and low-deductible health plans across 15 states, primarily HMO-based. These plans are suitable for those seeking comprehensive coverage under the ACA framework.

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  • Short-Term Medical (STM)

Not available through Molina, focusing instead on longer-term government programs.

  • Employer-Sponsored Plans

Limited options, with the company’s emphasis primarily on public programs.

  • Student Health Plans

Not offered.

  • Medicaid

Extensive Medicaid contracts support services such as TANF, CHIP, and ABD across numerous states. For more details, view Molina’s Medicaid service areas.

Medicare (65+)

  • Medicare Advantage (Part C)

Provides Medicare Advantage plans, including $0 premium HMO options with prescription drug coverage, predominantly in over 15 states. Focus is placed on Dual-Eligible Special Needs Plans (D-SNPs) to simplify benefits for qualifying individuals.

  • Medicare Supplement (Medigap)

Not available through Molina.

  • Part D Prescription Drug Plans

Most Medicare Advantage plans include Part D coverage; standalone Part D plans are not offered separately.

  • Medicare-Medicaid Plans (MMPs)

Integrated plans designed for dual-eligible beneficiaries are available in some states like Illinois and California, facilitating coordinated care.

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  • Retiree Group Medicare

Not publicly offered, but some plans may be available through employer programs.

Recent Changes in Cost and Options (2026)

Premiums and Rate Changes

Molina continues to lead in providing affordable ACA coverage, with average individual premiums around $395 per month. Many Medicare Advantage plans maintain $0 premiums, making them attractive options for seniors seeking cost-effective coverage.

Out-of-Pocket Costs

Members benefit from low deductibles—averaging approximately $2,542 for ACA plans—and reduced maximum out-of-pocket (MOOP) limits in Medicare Advantage, which can be as low as $6,000 in some regions.

Medicare Advantage Updates

This year, supplemental benefits have been enhanced, including new vendors for hearing aids, meal delivery, and OTC products, reflecting ongoing efforts to improve member benefits and convenience. For insights into technological advancements in healthcare, see how AI is transforming medical practices.

Plan Enhancements

Molina continues to focus on innovative programs such as doula services, wellness incentives, and addressing social health needs, aiming to provide holistic care that extends beyond traditional medical services.

Network Agreements

Network arrangements are subject to ongoing revisions; plans are still primarily HMO-based, which may limit flexibility but can offer more coordinated care within the network.

Consumer Experience Snapshot

Complaint Index

Molina’s complaint rate exceeds industry averages, with particular concerns related to customer service, billing disputes, and limitations within provider networks.

Satisfaction Scores

According to CMS, the average star rating for Molina’s Medicare Advantage plans is around 3.0 out of 5. NCQA ratings typically fall between 2.0 and 3.0, indicating moderate satisfaction but room for improvement.

Methodology

Our health insurance ratings evaluate insurers across five main categories, each scored from 1 to 10. These include coverage breadth, accessibility, plan diversity, affordability, innovation, and member experience. The overall score is an average of these components, derived from public data, regulatory filings, and expert analysis.

Final Thoughts

Molina Healthcare remains an attractive option for individuals and families with limited incomes, especially those qualifying for Medicaid or dual-eligibility programs. Its low premiums, reduced out-of-pocket costs, and expanding state contracts position it as a cost-effective choice for many. However, limited plan variety, regional coverage restrictions, and moderate satisfaction scores suggest it may not be suitable for those seeking broad network access or premium service quality. For further insights into innovative healthcare delivery, consider exploring how Servreality bridges the gap with extended reality technology.

Best suited for

Budget-conscious individuals, dual-eligible beneficiaries, and those prioritizing affordability within Medicaid and ACA plans.

Less ideal for

Individuals seeking PPO plans, comprehensive Medigap coverage, nationwide accessibility, or high-touch customer support.

The opinions expressed are those of the authors and do not necessarily reflect the official stance of HealthCareInsider.com or affiliated organizations.