2022 Annual Materials
Annual Notice of Change (ANOC): describes changes to your Molina plan coverage, costs or service area.
Summary of Benefits: a summary of what we cover and what you pay. For a complete list of covered services and exclusions, refer to your Evidence of Coverage.
Evidence of Coverage (EOC): your Medicare health benefits and services and prescription drug coverage as a member of Molina Medicare Complete Care.
Provider & Pharmacy Directory
A current list of our plan’s network providers and pharmacies for 2022.
Pharmacy & Prescription Drugs Materials
LIS Premium Summary: explains your monthly plan premium if you get Extra Help paying for your prescription drugs.
Formulary: a list of the drugs covered in this plan.
Medicare Part D Coverage Determination Request Form (download and mail or fax form)
Molina Drug Transition Policy
Drugs Requiring Prior Authorization
Search the pharmacy drug list here
Search for a pharmacy here
2022 Member Information
Notice of Privacy Practices: This document explains the steps Molina takes to protect your Personal Health Information (PHI).
Notice of Nondiscrimination: This document explains our policies on nondiscrimination.
Multi-Language Interpreter Services: This document explains how to get help if you speak languages other than English.