Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences

• Molina Healthcare primarily offers HMO plans, especially within Medicaid, ACA Marketplace, and Medicare Advantage. These require a primary care provider (PCP) and referrals for specialist visits.
• UnitedHealthcare (UHC) provides a wide array of plan types including HMO, PPO, POS, and EPO, giving members more flexibility and choice. Their PPO plans are especially popular for offering nationwide provider access without referrals.

Individual Plans vs. Employer-Sponsored Plans

• Molina specializes in individual plans through ACA marketplaces and Medicaid, with very limited presence in employer-sponsored group plans.
• UnitedHealthcare is a major player in the employer-sponsored insurance space and also offers individual and family plans, including ACA options.

Medicare Advantage vs. Medicare Supplement

• Molina focuses heavily on Medicare Advantage, particularly Dual Special Needs Plans (D-SNP) for people eligible for both Medicare and Medicaid. It does not offer Medigap (Medicare Supplement) plans.
• UnitedHealthcare offers both Medicare Advantage (especially through AARP-branded plans) and Medigap (Supplement) plans, with nationwide availability and broad provider networks.

Medicaid and ACA Marketplace Options

• Molina is one of the top insurers for Medicaid managed care and ACA marketplace coverage, especially in underserved areas.
• UnitedHealthcare also offers Medicaid and ACA marketplace plans, but its presence in ACA exchanges varies by state.

Cost & Affordability

Monthly Premiums Comparison

• Molina typically offers lower premiums, especially in Medicaid and ACA markets, making it attractive for low-income individuals.
• UnitedHealthcare tends to have higher premiums, particularly for PPO and employer plans, but also provides $0 premium Medicare Advantage plans in some markets.

Deductibles and Copayments

• Molina plans often come with low or no deductibles, particularly in Medicaid or subsidized ACA plans.
• UnitedHealthcare offers a broader range of deductible options—higher in PPOs, lower in HMOs—with clear copayment structures.

Out-of-pocket Maximums

• Molina usually provides lower out-of-pocket maximums, which is ideal for cost-sensitive enrollees.
• UnitedHealthcare offers moderate to high out-of-pocket limits, depending on the plan type and market.

Pricing Transparency

• Molina provides good pricing transparency for ACA and Medicaid plans, though digital tools are more basic.
• UnitedHealthcare excels in transparency with detailed cost estimators, digital tools, and real-time benefit lookup features.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks

• Molina has a smaller, regional network, usually focused in Medicaid-heavy urban and underserved areas.
• UnitedHealthcare boasts one of the largest national provider networks, including a vast range of doctors, hospitals, and specialists.

Specialist Access and Referrals

• Molina HMO plans require referrals from PCPs for specialist access.
• UnitedHealthcare PPO and POS plans do not require referrals, giving more flexibility to access specialists.

Availability of In-network Hospitals and Doctors

• Molina is strong in community clinics and regional hospitals, especially for Medicaid populations.
• UnitedHealthcare offers access to major hospital systems and top-rated providers across the country.

Out-of-network Coverage and Reimbursement Rates

• Molina generally does not cover out-of-network care, except for emergencies.
• UnitedHealthcare PPO plans provide robust out-of-network benefits and fair reimbursement rates.

Member Benefits & Perks

Wellness Incentives (Fitness Memberships, Preventive Screenings)

• Molina offers basic wellness programs, including preventive screenings and health education but lacks extensive fitness perks.
• UnitedHealthcare includes fitness incentives (e.g., Renew Active), wellness rewards, and preventive care across many plans.

Chronic Disease Management Programs

• Molina provides targeted support for chronic conditions like diabetes and asthma, especially for Medicaid and Medicare Advantage members.
• UnitedHealthcare delivers comprehensive disease management, including remote monitoring, coaching, and personalized treatment plans.

Telehealth and Virtual Care Offerings

• Molina offers telehealth through third-party partners, focused on basic care and behavioral health.
• UnitedHealthcare has an advanced telehealth ecosystem (e.g., Doctor on Demand, Amwell), integrated into its app for 24/7 care.

Mental Health Coverage and Services

• Molina includes mental health and behavioral services, especially within Medicaid/Medicare, though networks may be limited.
• UnitedHealthcare offers extensive mental health coverage, including virtual therapy and psychiatric consultations, with large provider networks.

Customer Service & Member Experience

Customer Satisfaction Ratings (J.D. Power, NCQA)

• Molina receives average satisfaction ratings, often due to limited networks or administrative hurdles.
• UnitedHealthcare tends to rank higher in member satisfaction, especially for Medicare and employer-sponsored plans.

Ease of Claims Processing and Disputes

• Molina’s claims process is basic but can experience delays, particularly in Medicaid regions.
• UnitedHealthcare is known for efficient claims handling, especially in employer and Medicare segments.

Quality and Usability of Online Portals/Apps

• Molina’s digital experience is functional but limited, with fewer advanced features.
• UnitedHealthcare offers highly-rated mobile apps and portals, with plan management, telehealth, and wellness tools built-in.

Responsiveness of Customer Support

• Molina’s support varies by region; some members report longer response times.
• UnitedHealthcare has more consistent, multichannel support, including live chat, phone, and mobile access.

Reputation & Financial Stability

Financial Strength Ratings (A.M. Best, Moody’s, S&P)

• Molina holds solid ratings (BBB to A-), reflecting steady performance in government programs.
• UnitedHealthcare has strong financial ratings (A to A+), showing robust revenue and claims-paying ability.

Company Reputation and Market History

• Molina Healthcare has built a strong reputation since 1980 in public health insurance (Medicaid/ACA).
• UnitedHealthcare is a national leader, with decades of dominance across Medicare, employer, and individual markets.

Consumer Complaints and Regulatory Issues

• Molina faces occasional regulatory scrutiny, especially in state Medicaid programs.
• UnitedHealthcare has a lower complaint ratio, although issues with billing and provider networks can occur in some states.

Medicare-specific Criteria

Medicare Star Ratings & Member Satisfaction

• Molina’s Medicare Advantage plans often earn 3.5 to 4 stars, with strong performance in D-SNP markets.
• UnitedHealthcare Medicare Advantage plans typically score 4 to 4.5 stars, with AARP branding boosting credibility and satisfaction.

Medicare Advantage Plan Additional Benefits

• Molina includes dental, vision, hearing, transportation, and OTC in many Medicare Advantage plans.
• UnitedHealthcare offers a wider array of benefits, including gym memberships (Renew Active), meal delivery, and caregiver support.

Availability and Quality of Medigap (Supplement) Plans

• Molina does not offer Medigap plans.
• UnitedHealthcare is a top provider of Medigap, especially through AARP-endorsed policies, available in nearly every state.

Cost-sharing Details Specific to Medicare

• Molina Medicare plans are built to limit cost-sharing, especially for low-income members.
• UnitedHealthcare offers more comprehensive cost control, including low or $0 copays, annual caps, and tiered prescription drug costs.

Employer & Small-Business Focus

Options for Small-Business Health Plans

• Molina has minimal offerings for employer groups.
• UnitedHealthcare is a top provider of small-business health plans, including fully insured and level-funded options.

Fully Insured vs. Self-Funded Plans

• Molina primarily handles government-funded plans, with limited commercial offerings.
• UnitedHealthcare offers a wide array of fully insured, self-funded, and level-funded plans, tailored to business size and budget.

Employee Wellness Initiatives and Incentives

• Molina’s programs are more community-based and tailored to public health goals.
• UnitedHealthcare delivers employee wellness platforms, health coaching, biometric screenings, and reward programs.

Customization and Flexibility of Group Policies

• Molina: Not designed for customized group benefits.
• UnitedHealthcare: Highly customizable group health plans with value-added services and tech integration.