Molina Healthcare Review (2026): Cost, Pros & Cons

Molina Healthcare is worth it for cost-focused Gold buyers. Molina's Gold HMO averages $616 a month for a 40-year-old, $83 below the $699 national Gold average, and it's the only tier sold in all 12 Molina states. Gold plans pay 80% of covered costs on average, compared with 70% for Silver.

Buyers who see specialists often or manage chronic conditions get less from Molina Healthcare. Every Molina plan is an HMO, so a primary care physician coordinates care and refers members to specialists. Molina also denies 24% of claims, compared with 18% nationally.

Molina's medical care score from CMS Quality Rating System data, 67.47, is 9.13 points below the 76.60 national average, a concern for buyers with chronic conditions.

Molina Healthcare sells only HMO plans on the ACA marketplace. In an HMO (health maintenance organization), a primary care physician coordinates your care and must refer you to most specialists. Federal rules still let you see an in-network OB-GYN without a referral and cover out-of-network emergency care. 

Molina doesn't sell PPO or EPO plans. PPOs let members see specialists without a referral and cover out-of-network care. Buyers who rarely see specialists give up the least for Molina's Gold premium, $83 a month below the national Gold average. 

Tier options vary by state. Molina sells Gold in all 12 states and Silver in 11, but Platinum and Catastrophic only in California. Molina also sells Medicaid and Medicare Advantage plans, which are separate from its marketplace lineup.

Molina's Gold HMO averages $616 a month for a 40-year-old across the 12 states where it's sold, $83 below the $699 national Gold average. Five of Molina's six metal levels price below their national averages. Catastrophic is the exception: California's plan for 26-year-olds costs $63 more than average, so buyers under 30 there should compare other insurers.

Molina's premiums in the table are unsubsidized. Beyond the premium, two figures set your yearly cost: the deductible, what you pay before the plan shares most costs, and the maximum out-of-pocket limit (MOOP), the most you'll pay for covered in-network care in a year.

*Molina figures are averages across the states where each metal level is sold, for a 40-year-old, except Catastrophic, priced for a 26-year-old. Platinum and Catastrophic reflect Molina's single California plan in each tier. Bronze reflects California and Washington plans.   

Across Molina's states, its Gold average is $10 below its $626 Silver average, with a $1,387 deductible against Silver's $4,472, though the Silver average excludes Washington. Where Molina's Gold costs less than its Silver at your ZIP code, full-price buyers pay less for Gold's 80% average coverage level, 10 points above Silver's 70%.   

Tax-credit-eligible buyers with incomes up to 250% of the federal poverty level should compare Silver first. Cost-sharing reductions, which cut deductibles and copays for eligible buyers, apply only to Silver plans. 

California's Platinum plan has a $0 deductible and a $5,000 MOOP, so the plan shares costs from the first visit and your copays and coinsurance stop at $5,000 a year.

Molina trails the national average on its overall CMS Quality Rating System (QRS) score, 69.50 compared with 79.39, and on all three QRS categories. Medical care (9.13 points below average) and plan administration (8.90 points below) show the largest shortfalls.

Molina denies 24% of claims, 6 percentage points above the 18% national average, so a claim is a third more likely to be denied. Buyers who file frequent claims for specialist or chronic-condition care do the most appeals work. 

Member experience is Molina's closest QRS score to average, 92.21 compared with 94.59, and its 2.38-point shortfall is one-quarter the size of its 9.13-point medical care shortfall. The category reflects members' ratings of their doctors, care and appointment access. Customer service counts toward plan administration, where Molina trails by 8.90 points.

Molina Healthcare sells 111 ACA marketplace plans across 12 states for 2026. Florida and Ohio have the most, at 22 each. Gold is the only metal level sold in all 12 states, and California is the only state with Platinum and Catastrophic plans. Molina's Medicaid and Medicare Advantage plans are sold under separate contracts. 

Molina's marketplace plans aren't required to cover care outside the U.S., so Molina members who travel abroad should buy a travel health insurance policy for medical emergencies. 

In Idaho, Illinois, Mississippi, Nevada, New Mexico, South Carolina, Texas and Utah, Molina sells only Silver and Gold plans. Washington is the only Molina state without a Silver plan. Molina sells only Bronze and Gold there, so Washington buyers eligible for cost-sharing reductions, which apply only to Silver, can't use them with Molina.

Molina's ACA marketplace plans continue in all 12 states for 2026 and aren't affected by its Medicare changes. In its February 2026 earnings report, Molina announced it will exit the Medicare Advantage Part D market in 2027 and shift its focus toward dual-eligible members, who qualify for both Medicaid and Medicare. 

Members of Molina's traditional Medicare Advantage Prescription Drug (MAPD) plans should review their 2027 options, such as another Medicare Advantage plan with drug coverage or Original Medicare with a standalone Part D drug plan. Medicare.gov's plan finder compares options during open enrollment, Oct. 15 to Dec. 7, 2026.

Molina Healthcare marketplace plans include four member programs at no additional cost for 2026:

• Free 24/7 Telehealth (Teladoc): Teladoc visits cost nothing out of pocket and run 365 days a year for non-emergency care. For a minor illness, that's a $0 alternative to an urgent care visit.
• Wellness Rewards: Complete your annual wellness visit and health questionnaire for up to $200 in gift cards. Preventive screenings come at no cost.
• My Molina App: The app lets you search for in-network doctors and review your claims. It also holds your digital member ID card and lets you switch your primary care provider from your phone without calling member services.
• 24/7 Nurse Line: Registered nurses are available any time of day, in your language. They assess your symptoms and answer your health questions before you decide whether to seek care.

Member program availability varies by state. Contact Molina directly to confirm which benefits apply to your plan.

Molina's $0 Teladoc visits matter most on Bronze plans, sold in California and Washington, where the $5,891 average deductible is $4,504 above Gold's $1,387, so more in-person sick visits fall before the deductible. A Teladoc call for a minor illness lowers out-of-pocket costs without changing the premium.

Molina's California Silver 70 HMO, the default view, costs $491 a month for a 40-year-old, $135 below Molina's $626 average Silver premium. Its $5,200 deductible is $728 above Molina's $4,472 Silver average. Filter by state, age and metal level for Molina's plans in your area.

* Rates shown are actual plan premiums for the selected state and age. Molina's cost-table averages combine every state where each metal level is sold.

Molina Healthcare sells ACA marketplace coverage in 12 states, with 111 plans for 2026, and focuses on Medicaid and dual-eligible members, who qualify for both Medicaid and Medicare. Its marketplace lineup is HMO-only, and Gold is the only metal level it sells in all 12 states.   

Outside those 12 states, Molina has no marketplace plans. Premium tax credits apply to marketplace plans in every state. HealthCare.gov shows your subsidized price in Florida, Mississippi, Ohio, South Carolina, Texas and Utah. Residents of California, Idaho, Illinois, Nevada, New Mexico and Washington use their state's own marketplace instead.

MoneyGeek rates health insurance providers on affordability (premiums, deductibles and out-of-pocket maximums), customer experience and claim denial rates.

MoneyGeek health insurance provider scores are weighted as follows:

• Affordability (60%): When scoring providers on affordability, we considered monthly premiums, deductibles and maximum out-of-pocket (MOOP) costs. We weighted these factors as follows within the affordability score: monthly premiums (66.67%), deductible (16.67%), MOOP (16.67%).
• Customer Experience (30%): CMS's Quality Rating System (QRS), published as 1-to-5-star ratings for an overall score and for the Medical Care, Member Experience and Plan Administration categories.
• Denial Rate (10%): Denial rate is the percentage of submitted claims an insurer denies. Providers with the lowest denial rate get the highest score.

Data sources

Health insurance plan and provider data was updated with the Centers for Medicare & Medicaid Services (CMS) exchange data released in October 2025 for the 2026 enrollment period as well as manual collection of health plan data from state insurance marketplaces for 22 states.

Sample consumer profile

We collected data on all available health plans for consumers ages 18, 26, 40, 50 and 60. Monthly premiums are based on a 40-year-old buyer unless otherwise noted, such as Catastrophic plans, which are priced for a 26-year-old. We analyzed plans for each cited metal tier, which include Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum.