H7678 Medicare Plan: Eligibility, Benefits, Costs & Enrollment Guide

Table of Contents#

1. What is the H7678 Medicare Plan?
2. Eligibility Requirements for H7678
3. Key Benefits of the H7678 Medicare Plan
   • Inpatient Hospital Coverage (Part A)
   • Outpatient Medical Coverage (Part B)
   • Prescription Drug Coverage (Part D)
   • Additional Benefits
4. Costs of the H7678 Medicare Plan
   • Monthly Premiums
   • Deductibles
   • Copays and Coinsurance
   • Out-of-Pocket Maximum
5. How to Enroll in H7678
6. Pros and Cons of H7678
7. Frequently Asked Questions (FAQs)
8. Conclusion
9. References

What is the H7678 Medicare Plan?#

The H7678 Medicare Plan is a Medicare Advantage (MA) plan, also known as Part C. MA plans are offered by private insurers contracted with the Centers for Medicare & Medicaid Services (CMS) to provide Medicare benefits. Each MA plan has a unique identifier assigned by CMS to track plan details, such as the insurer, service area, and coverage. H7678 is the CMS contract ID for Molina Medicare Complete Care (HMO D-SNP), a Dual Eligible Special Needs Plan offered by Molina Healthcare in Texas. As a D-SNP, it serves beneficiaries who are eligible for both Medicare and Medicaid.

H7678 replaces Original Medicare (Parts A and B) and includes:

• All benefits covered by Original Medicare (hospital, medical, and preventive care).
• Built-in prescription drug coverage (Part D).
• Extra benefits not covered by Original Medicare, such as dental, vision, hearing, and wellness programs.

Like all MA plans, H7678 must follow federal guidelines but can vary in costs, coverage, and provider networks. Always verify plan details through Medicare.gov or the plan's official Summary of Benefits.

Eligibility Requirements for H7678#

To enroll in the H7678 Medicare Plan, you must meet the following criteria:

1. Enrolled in Medicare Parts A and B#

You must have both Medicare Part A (hospital insurance) and Part B (medical insurance). Most people qualify for Part A premium-free if they've worked 10+ years (40 quarters) and paid Medicare taxes. Part B requires a monthly premium ($202.90/month in 2026 for most enrollees).

2. Reside in the Plan's Service Area#

H7678 is only available in specific Texas counties, including Atascosa, Bandera, Cameron, Comal, Duval, Guadalupe, Hudspeth, Jim Hogg, Kendall, Maverick, McMullen, Medina, Starr, Webb, Willacy, Wilson, and Zapata. You must live in the plan's designated service area to enroll. Check Medicare.gov's Plan Finder to confirm coverage in your location.

3. Eligible for Both Medicare and Medicaid (Dual Eligible)#

Because H7678 is a Dual Eligible Special Needs Plan (D-SNP), you must be enrolled in both Medicare and Medicaid to qualify. This sets it apart from standard MA plans.

4. Not Enrolled in Another Medicare Advantage Plan#

You cannot be enrolled in another MA plan when joining H7678. If you have a Medigap (Medicare Supplement) plan, you'll need to drop it before enrolling.

5. End-Stage Renal Disease (ESRD) Eligibility#

Since 2021, people with ESRD can enroll in Medicare Advantage plans, including D-SNPs like H7678. Previously, ESRD beneficiaries were generally excluded from MA plans except in limited circumstances.

Key Benefits of the H7678 Medicare Plan#

H7678's benefits are designed to mirror or exceed Original Medicare, with added perks. Below is a breakdown of core and optional benefits:

Inpatient Hospital Coverage (Part A)#

H7678 covers all Part A services, including:

• Hospital stays: Semi-private rooms, meals, nursing care, and medications administered during your stay.
• Skilled Nursing Facility (SNF) care: Up to 100 days per benefit period for post-hospital rehabilitation (e.g., after surgery).
• Hospice care: For terminal illness, including pain management, counseling, and home health aide services.
• Home health care: Part-time skilled nursing, physical therapy, or occupational therapy for homebound patients.

Outpatient Medical Coverage (Part B)#

H7678 includes Part B benefits, such as:

• Doctor visits: Primary care physicians (PCPs), specialists, and urgent care visits.
• Preventive services: Free annual wellness exams, flu shots, cancer screenings (e.g., mammograms, colonoscopies), and vaccinations (e.g., shingles).
• Diagnostic tests: Lab work, X-rays, MRIs, and CT scans.
• Durable Medical Equipment (DME): Wheelchairs, walkers, oxygen tanks, and other devices prescribed by a doctor.

Prescription Drug Coverage (Part D)#

H7678 includes built-in Part D coverage. Key details:

• Formulary: A list of covered drugs, organized into tiers (lower tiers = lower costs).
• Cost-sharing: Copays or coinsurance for prescriptions, with higher tiers (e.g., brand-name or specialty drugs) costing more. Under the H7678 D-SNP, most prescription copays are $0 for dual-eligible beneficiaries.
• Coverage stages: Deductible, initial coverage, and catastrophic coverage. The Part D coverage gap ("donut hole") was eliminated in 2025 under the Inflation Reduction Act. In 2026, the out-of-pocket threshold for catastrophic coverage is $2,100. The maximum Part D deductible is$615 in 2026.

Additional Benefits#

H7678 offers extra benefits not covered by Original Medicare, such as:

• Dental care: Preventive and comprehensive dental services, including cleanings, fillings, crowns, and dentures, with up to $4,000 in annual coverage.
• Vision care: Eye exams, glasses, contact lenses, and eyeglass frames, with up to $200 in annual eyewear benefits.
• Hearing care: Hearing exams and hearing aids (up to 2 hearing aids every two years).
• Over-the-counter items: $26 monthly allowance for OTC health products, including OTC hearing aids.
• Wellness programs: Gym memberships (e.g., SilverSneakers), nutrition counseling, or mental health services.
• Telehealth: Virtual doctor visits for non-emergency care.

Costs of the H7678 Medicare Plan#

Costs for H7678 vary based on your Medicaid eligibility and location. Below are common cost components for 2026:

Monthly Premiums#

• MA Plan Premium: H7678 has a $0 monthly premium for dual-eligible beneficiaries. The plan also offers a$1 Part B premium rebate (giveback).
• Part B Premium: You must still pay the standard Part B premium ($202.90/month in 2026) unless you qualify for financial assistance through Medicaid or a Medicare Savings Program.
• Part D Premium: H7678 includes Part D coverage at no additional premium.

Deductibles#

• Medical Deductible: H7678 has a $0 medical deductible.
• Drug Deductible: H7678 has a $0 drug deductible. The maximum Part D deductible allowed in 2026 is$615.

Copays and Coinsurance#

• Copays: H7678 offers $0 copays for most services, including primary care visits, specialist visits, urgent care, emergency room visits, inpatient hospital stays, and prescription drugs.
• Coinsurance: Most services under H7678 have $0 coinsurance for dual-eligible members.

Out-of-Pocket Maximum#

A key advantage of MA plans like H7678 is the out-of-pocket maximum (OOPM). In 2026, the federal OOPM limit for MA plans is $9,250 for in-network services. Once you reach this limit, the plan covers 100% of covered services for the rest of the year. Under H7678, most dual-eligible members pay little to nothing out of pocket.

How to Enroll in H7678#

Enrollment in H7678 is only allowed during specific periods. Follow these steps:

1. Check Eligibility and Service Area#

Confirm you meet the eligibility criteria (Parts A/B enrollment, dual Medicare-Medicaid eligibility, Texas residency) and that H7678 is available in your county via Medicare.gov's Plan Finder.

2. Compare Plan Details#

Review the plan's Summary of Benefits, provider network, and costs to ensure it aligns with your needs. You can find H7678 plan documents on Medicare.gov's Plan Finder or request them directly from Molina Healthcare.

3. Enroll During Open Enrollment Periods#

• Initial Enrollment Period (IEP): 7 months around your 65th birthday (3 months before, the month of, and 3 months after).
• Annual Enrollment Period (AEP): October 15 – December 7 each year (coverage starts January 1).
• Special Enrollment Period (SEP): For life events (e.g., moving, losing other coverage, gaining or losing Medicaid eligibility).

4. Submit Enrollment#

Enroll online via Medicare.gov, by phone (1-800-MEDICARE), through Molina Healthcare, or with a licensed insurance agent. Molina's Medicare advisors can be reached at (855) 814-8974 (TTY: 711).

Pros and Cons of H7678#

Pros#

• **$0 costs for dual-eligible members**:$0 premium, $0 deductibles, and$0 copays for most services.
• All-in-one coverage: Combines Parts A, B, and D in a single plan.
• Extra benefits: Dental ($4,000/year), vision ($200/year), hearing aids, and $26/month OTC allowance.
• Out-of-pocket protection: OOP maximum limits annual costs.
• Medicaid coordination: Designed specifically for beneficiaries with both Medicare and Medicaid.

Cons#

• Network restrictions: As an HMO plan, you must use in-network providers (except for emergencies). Out-of-network care may not be covered.
• Dual-eligible requirement: Only available to people enrolled in both Medicare and Medicaid.
• Limited service area: Only available in select Texas counties.
• Prior authorization: Some services require prior authorization from the plan.

Frequently Asked Questions (FAQs)#

Q: Is H7678 available nationwide?
A: No. H7678 is only offered in select Texas counties. Use Medicare.gov's Plan Finder to check availability in your area.

Q: Who is eligible for H7678?
A: H7678 is a Dual Eligible Special Needs Plan (D-SNP), so you must be enrolled in both Medicare and Medicaid to qualify. You must also live in one of the plan's Texas service area counties.

Q: Can I keep my current doctor with H7678?
A: H7678 is an HMO plan, so you must use in-network providers for non-emergency care. Check Molina Healthcare's provider directory to see if your doctors are in the network.

Q: Does H7678 cover emergency care?
A: Yes, emergency and urgent care are covered nationwide, even out-of-network, with a $0 copay.

Q: Does H7678 include prescription drug coverage?
A: Yes, H7678 includes built-in Part D prescription drug coverage with $0 copays for most medications for dual-eligible members.

Q: How often can I switch to H7678?
A: You can switch during AEP (Oct 15–Dec 7), during your IEP, or during a SEP if you qualify due to a life event.

Conclusion#

The H7678 Medicare Plan (Molina Medicare Complete Care HMO D-SNP) offers a comprehensive alternative to Original Medicare for dual-eligible beneficiaries in Texas, with $0 premiums,$0 deductibles, and extensive additional benefits. To decide if it's right for you, confirm your dual-eligible status, verify that your county is in the service area, and check that your preferred providers and medications are covered. Always review the plan's official Summary of Benefits or contact Molina Healthcare directly for the most up-to-date details.

References#

• Centers for Medicare & Medicaid Services. (2025). 2026 Medicare Parts A & B Premiums and Deductibles. https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
• Medicare.gov. (2026). Plan Finder Tool. https://www.medicare.gov/plan-compare/
• Medicare.gov. (2026). How much does Medicare drug coverage cost? https://www.medicare.gov/health-drug-plans/part-d/basics/costs
• Molina Healthcare. (2026). Molina Medicare Complete Care (HMO D-SNP) Summary of Benefits. https://www.molinahealthcare.com/members/tx/en-us/mem/medicare/-/media/Molina/PublicWebsite/PDF/members/common/en-us/Medicare/2026%20Documents/Summary%20of%20Benefits/TX006-002-2026-SNP-SB-EN-508
• National Council on Aging. (2026). What You'll Pay in Out-of-Pocket Medicare Costs in 2026. https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2026/
• National Kidney Foundation. (2026). Medicare Advantage (MA) Plans. https://www.kidney.org/medicare-advantage-ma-plans