Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Molina Medicare Complete Care, 2027

H5628Contract001Plan

HMO D-SNP · special needs plan, dual-eligible · 23 counties in Utah

Run by Molina Healthcare of Utah, Inc. (contract H5628), sold as Molina Healthcare of Utah & Idaho, owned by Molina Healthcare, Inc.

Renews for 2027

2026 star rating, contract H5628: 3 of 5

Molina Medicare Complete Care (H5628-001) costs $45.50 a month in 2027, up $27.20 from 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Monthly premium	$18.30	$45.50	up $27.20
In-network out-of-pocket limit	$9,250	$9,850	up $600
Drug deductible	$615	$700	up $85
Primary care visit	30% of the cost	29% of the cost	changed
Hospital stay, in network	not filed	$2,241 a stay	changed
Skilled nursing facility, in network	not filed	$0 a day for days 1–20, then $221 a day for days 21–100	changed
Drug tier 2, generic	10% of the cost	25% of the cost	up 15 points
Drug tier 3, preferred brand	20% of the cost	25% of the cost	up 5 points
Drug tier 4, non-preferred drug	30% of the cost	26% of the cost	down 4 points
13 lines do not change
Part B premium reduction, monthly	none	none	no change
Specialist visit	30% of the cost	30% of the cost	no change
Emergency room	30% of the cost	30% of the cost	no change
Medical deductible, in network	none	none	no change
Ground ambulance, in network	20% of the cost	20% of the cost	no change
Comprehensive dental, yearly limit	$1,000 a year	$1,000 a year	no change
Eyewear, yearly limit	$250 a year	$250 a year	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Over-the-counter items, yearly	not offered	not offered	no change
Counties served	23	23	no change
Drug tier 1, preferred generic	$0	$0	no change
Drug tier 5, specialty tier	25% of the cost	25% of the cost	no change
Drug tier 6, select care drugs	$0	$0	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	$0	$0
Tier 2	Generic	10% of the cost	25% of the cost
Tier 3	Preferred Brand	20% of the cost	25% of the cost
Tier 4	Non-Preferred Drug	30% of the cost	26% of the cost
Tier 5	Specialty Tier	25% of the cost	25% of the cost
Tier 6	Select Care Drugs	$0	$0

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 11 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 1 plan has a lower out-of-pocket limit, 9 the same. On the premium, 10 plans have a lower premium.

Out-of-pocket limits of the 11 dual-eligible special needs plans

$0 to under $2,0000 plans

$2,000 to under $4,0000 plans

$4,000 to under $6,0001 plan

$6,000 to under $8,0000 plans

$8,000 to $10,000 (this plan)10 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 23 counties: $45.50 a month and $9,850.

Utah

Beaver Box Elder Cache Davis Duchesne Emery Garfield Iron Juab Kane Millard Morgan Piute Rich Salt Lake Sanpete Sevier Tooele Utah Wasatch Washington Wayne Weber

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H5628-001
Legal name of the contract: Molina Healthcare of Utah, Inc.
Sold as: Molina Healthcare of Utah & Idaho
Parent company: Molina Healthcare, Inc.
Plan type: HMO D-SNP
2026 star rating of the contract: 3 of 5 overall; health plan 3 of 5, drug plan 3.5 of 5
Members, September 2026: 3,403
Plan website, as filed with CMS: https://www.molinahealthcare.com/members/ut/en-us/

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Salt Lake, UTWhere most of its members live; premiums and limits side by side
Every Molina Healthcare of Utah & Idaho plan for 2027Its contracts, counties and plans that end
The other 1 plan of contract H5628Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.