Parity

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Molina Gold Care

Molina · gold · Molina Marketplace

$8,880 / year

Individual deductible

$1,500

Family deductible

$3,000

Individual OOP max

$5,500

Family OOP max

$11,000

Primary care copay

$25

Specialist copay

$55

ER copay

$300

Coinsurance

$0

Rx generic

$10

Rx brand

$40

Rx specialty coins.

30%

Coverage matrix

Rx tiers, prior auth, mental health, maternity, rehab, DME, telehealth

Rx · Generic (Tier 1)

Low copay; mail-order 90-day often available.

Covered

Rx · Preferred brand (Tier 2)

Preferred brand copay; step therapy uncommon for preferred list.

Covered

Rx · Non-preferred brand (Tier 3)

Non-preferred brands typically need exception or higher cost-share.

Limited

Rx · Specialty (Tier 4)

Specialty drugs almost always require prior authorization + specialty pharmacy.

Prior auth

Prior authorization

Imaging, specialty Rx, some surgeries, and DME commonly require PA.

Prior auth

Mental health & substance use

Parity with medical; tele-behavioral health included.

Covered

Maternity & newborn

Prenatal, delivery, and newborn covered as EHB; confirm OB network.

Covered

Rehab & physical therapy

Outpatient PT/OT/ST; visit limits vary by plan year.

Covered

Durable medical equipment (DME)

DME typically coinsurance after deductible; prior auth for higher-cost items.

Prior auth

Telehealth

Telehealth available; cost-share may mirror office visits.

Limited

What IS covered

  • Community clinic partners
  • Preventive $0
  • Behavioral health

What is NOT covered

Clear callouts — never buried in footnotes

  • ✕Limited tertiary hospitals
  • ✕Some specialty centers

Network snapshot · ZIP 75201

Molina Marketplace

4

Hospitals

60

Primary care

150

Specialists

Filed facility prices vs modeled member share

Side-by-side for Molina Gold Care — hospital shoppable-service filed charges in the selected metro versus modeled plan cost-share for comparable episodes. Not live quotes; not insurance advice; not an EOB.

Filed
Modeled

Transparency metro

Dallas, TX · 75201

Switch curated hospital shoppable-service samples by metro. Educational data — not live MRF crawls or quotes; not insurance advice.

Comparing against transparency samples for Dallas, TX · 75201 (Dallas–Fort Worth (demo)).

ServiceFiled hospital charge
Filed
Modeled member share
Modeled

MRI brain without & with contrast

CPT-ish 70553

Comparable to medium-utilizer outpatient imaging (DEMO_SCENARIOS moderate MRI).

$1,920

Parkland Memorial Hospital

Filed

Median of 2 filed samples in ZIP

$1,920

Plan pays ~$0 (model)

Modeled
Deductible + coins
Deductible engaged

Fresh-deductible episode model using filed charge as allowed amount — educational only.

Emergency department visit, moderate severity

CPT-ish 99284

Modeled as plan ER copay (DEMO_SCENARIOS heavy includes an ER visit).

$1,280

Parkland Memorial Hospital

Filed

Median of 2 filed samples in ZIP

$300

Plan pays ~$980 (model)

Modeled
ER copay

Plan ER copay model — not an EOB; facility charge ≠ member bill.

Colonoscopy, diagnostic

CPT-ish 45378

Isolated outpatient procedure through deductible + coinsurance.

$2,750

Methodist Dallas Medical Center

Filed

Median of 2 filed samples in ZIP

$2,750

Plan pays ~$0 (model)

Modeled
Deductible + coins
Deductible engaged

Fresh-deductible episode model using filed charge as allowed amount — educational only.

Physical therapy evaluation

CPT-ish 97161

Comparable to medium-utilizer PT (per-evaluation illustration; not an 8-visit bundle).

$195

Parkland Memorial Hospital

Filed

Median of 2 filed samples in ZIP

$195

Plan pays ~$0 (model)

Modeled
Deductible + coins
Deductible engaged

Fresh-deductible episode model using filed charge as allowed amount — educational only.

Vaginal delivery

CPT-ish 594

Isolated inpatient-style allowed amount through deductible + coinsurance.

$16,200

Methodist Dallas Medical Center

Filed

Median of 2 filed samples in ZIP

$5,640

Plan pays ~$10,560 (model)

Modeled
Deductible + coins
Deductible engaged

Fresh-deductible episode model using filed charge as allowed amount — educational only.

Modeled shares assume an isolated episode (fresh deductible) using the filed charge as the allowed amount, or the plan's ER copay for ED visits. Filed columns are curated CMS shoppable-style samples (not a live hospital crawl). Facility list prices are not the same as negotiated rates or member bills. Not live quotes; not insurance advice. See Trust & compliance.

Search drugs & procedures

Find shoppable services by name or code in Dallas, TX · 75201. Facility charges labeled Filed; plan member share labeled Modeled when a plan is selected. Curated sample — not a live crawl. Not live quotes; not insurance advice.

Curated sample

Modeling member share with Molina Gold Care — educational estimate only.

Try a CPT/HCPCS code (e.g. 70553, J1100) or a name like MRI, colonoscopy, chest X-ray, metabolic, or dexamethasone.

Filed = illustrative CMS shoppable / transparency-style facility charges (curated sample, not a live hospital crawl). Modeled = educational plan member-share estimate when a plan is selected (deductible + coinsurance or ER copay). Not live quotes. Not an EOB. Not insurance or medical advice.

Facility price transparency

Shoppable-service style facility charges by metro — every row labeled filed or modeled. Not live quotes; not insurance advice.

Read-only

Transparency metro

Dallas, TX · 75201

Switch curated hospital shoppable-service samples by metro. Educational data — not live MRF crawls or quotes; not insurance advice.

Showing Dallas, TX (Dallas–Fort Worth (demo)). Demo Dallas household is fictional sample data — not a real member record.

2 filed
1 modeled
FacilityChargeProvenance

Parkland Memorial Hospital

Chest X-ray, 2 views · 71046

$265
Filed

Methodist Dallas Medical Center

Chest X-ray, 2 views · 71046

$390
Modeled

Baylor University Medical Center

Chest X-ray, 2 views · 71046

$420
Filed
Methodology & honesty labels
Parity facility price transparency (increments 2–6)

WHERE NUMBERS COME FROM
• CMS Hospital Price Transparency rules require hospitals to publish machine-readable
  files (MRFs) and a consumer shoppable-services list (typically ≥300 services) with
  gross charges, discounted cash prices, and payer-specific negotiated rates where
  applicable. Our "filed" samples are curated illustrative rows in that conceptual
  shape (CPT-ish shoppable services: MRI, ED visit, colonoscopy, childbirth, PT,
  chest X-ray, CT head, CMP lab, plus facility-administered Rx HCPCS e.g. J1100),
  not a live ingest of any hospital's MRF at runtime.
• ZIP scopes in this demo: Dallas 75201 (primary), Maine 03904 (example), plus NYC
  10001, Chicago 60611, Los Angeles 90012, Atlanta 30303, and Denver 80202.
  The Dallas household in demo-data is fictional — not any real user's PHI.
• Bundled CMS MRF sample loader (cmsMrfSampleLoader): read-only ingest of a small
  in-repo JSON/CSV fixture shaped like simplified shoppable rows. Explicitly labeled
  "sample file / not live crawl" — never a live hospital crawl or live quote.

WHAT IS MODELED
• "modeled" rows are educational estimates (metro medians / relative adjustments)
  used when we lack a filed-style sample for that facility×service. They are labeled
  modeled in every API and UI surface.
• Plan cost-share estimates elsewhere in Parity (deductible / coinsurance / OOP)
  remain separate modeled member-cost scenarios — not facility list prices.

PLAN DETAIL (increment 3)
• On /app/health/[planId], filed facility shoppable charges for the selected metro ZIP
  are shown side-by-side with modeled plan member cost-share (deductible + coinsurance
  or ER copay). See healthFiledVsModeled.ts. Badges remain Filed vs Modeled.

DRUG / PROCEDURE SEARCH (increment 4)
• Search box on /app/health (and transparency panel) matches shoppable services by
  name or code against the curated transparency dataset for the selected metro ZIP
  (parity_health_zip). Results list filed facility prices with Filed/Modeled badges;
  when a plan context is selected, a modeled member-share estimate is shown —
  otherwise a clear "no plan selected" note. See healthTransparencySearch.ts.
• Dataset remains curated/illustrative — not fake live feeds.

FAVORITES / ANNUAL CARE (increments 5–6)
• Users can favorite procedures/drugs from search or the facility panel; favorites
  persist on the household via AppState → localStorage (parity_app_v1). The health
  hub favorites list re-runs filed prices for the selected metro ZIP.
• Annual care scenario bundles primary care / PT / imaging / lab / Rx admin (plus
  optional favorites) into plan × estimated yearly member cost using filed facility
  prices + modeled cost-share. Increment 6 adds pediatric and pregnancy presets and
  clipboard/printable export of plan × estimated yearly member cost. See
  healthFavorites.ts and healthAnnualScenario.ts.

HONESTY
• Never treat these as live quotes, guarantees, or insurance advice.
• Always surface provenance badges: filed vs modeled.
• Sample MRF path uses parseCmsLikeJson / parseCmsLikeCsv → normalizeCmsLikeRow;
  source badge must read sample file / not live crawl.
• Metro ZIP picker (7 scopes) is first-class on /app/health; optional localStorage
  key parity_health_zip persists the selection.

Sample file / not live crawl — bundled fixture shaped like simplified CMS hospital price transparency shoppable rows. Parser demo only; not a live hospital MRF fetch, not live quotes, and not insurance advice.

See also Trust & compliance.

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Annual care scenario

Sample yearly bundle for Dallas, TX · 75201 — filed facility prices where available + modeled plan cost-share. Not insurance advice; not live quotes (sample dataset, not a live crawl).

Educational estimate

Adult (default) bundle

Primary care, PT, MRI, lab, and facility-admin Rx for a typical adult year.

  • Primary care office visits ×2 (plan copay · Modeled)
  • Physical therapy evaluation, low complexity
  • MRI brain without & with contrast
  • Comprehensive metabolic panel
  • Injection, dexamethasone sodium phosphate, 1 mg

Export plan × estimated yearly member cost (clipboard / print)

Loading plan estimates…

Printable export — Adult (default)

Dallas, TX · 75201 · plan × estimated yearly member cost · Filed / Modeled honesty

Parity — Annual care scenario
Metro / ZIP: Dallas, TX · 75201
Scenario: Adult (default) [adult]
Bundle: Primary care office visits ×2; Physical therapy evaluation, low complexity; MRI brain without & with contrast; Comprehensive metabolic panel; Injection, dexamethasone sodium phosphate, 1 mg

Plan × estimated yearly member cost (sorted low → high):
1. Molina Gold Care (Molina · gold)
   Premium: $8,880
   Est. care share: $2,282
   Est. annual member: $11,162
   Labels: Filed ×4 · Modeled ×5

Filed / Modeled: Estimated annual member cost = plan premium + educational care cost-share for this sample bundle. Filed = curated CMS shoppable-style facility charges for the selected metro ZIP (sample, not a live crawl). Modeled = plan deductible/coinsurance/copay applied to those charges (or PCP copay when no facility row). Not live quotes. Not an EOB. Not insurance or medical advice.
Methodology: curated CMS shoppable-style filed facility charges (sample, not a live crawl) + modeled plan deductible/coinsurance/copay for a shared plan year — educational estimate only; not advice.
Not insurance or medical advice. Sample dataset — not a live hospital crawl. Not a quote or EOB.

Methodology: curated CMS shoppable-style filed facility charges (sample, not a live crawl) + modeled plan deductible/coinsurance/copay for a shared plan year — educational estimate only; not advice.

Bundle line items & honesty labels

Services in this run: Primary care office visits (×2) · Physical therapy evaluation, low complexity · MRI brain without & with contrast · Comprehensive metabolic panel · Injection, dexamethasone sodium phosphate, 1 mg

  • Primary care office visits
    Modeled

    Member ~$50 — Plan primary-care copay × visits — no facility filed row; educational only.

  • Physical therapy evaluation, low complexity
    Filed
    Modeled

    Filed allowed ~$195 · Member ~$195 — Filed charge as allowed amount through shared-year deductible + coinsurance.

  • MRI brain without & with contrast
    Filed
    Modeled

    Filed allowed ~$1,920 · Member ~$1,920 — Filed charge as allowed amount through shared-year deductible + coinsurance.

  • Comprehensive metabolic panel
    Filed
    Modeled

    Filed allowed ~$95 · Member ~$95 — Filed charge as allowed amount through shared-year deductible + coinsurance.

  • Injection, dexamethasone sodium phosphate, 1 mg
    Filed
    Modeled

    Filed allowed ~$22 · Member ~$22 — Facility-administered Rx charge through shared-year deductible + coinsurance — not retail pharmacy copay.

Estimated annual member cost = plan premium + educational care cost-share for this sample bundle. Filed = curated CMS shoppable-style facility charges for the selected metro ZIP (sample, not a live crawl). Modeled = plan deductible/coinsurance/copay applied to those charges (or PCP copay when no facility row). Not live quotes. Not an EOB. Not insurance or medical advice.

Cost by utilizer scenario

Low / medium / high utilizer · family size 3 · premium + member medical/Rx

Low utilizer

$9,250

Care $370

Medium utilizer

$12,095

Care $3,215

High utilizer

$17,730

Care $8,850

Low utilizer — wellness + minor care

$9,250

Premium $8,880Medical $330Rx $40
Deductible engaged
  • Primary care visits$50
  • Annual labs$280
  • Generic Rx$40

Medium utilizer — specialist + imaging

$12,095

Premium $8,880Medical $3,055Rx $160
Deductible engaged
  • Primary care visits$75
  • Specialist visits$220
  • MRI (outpatient)$1,800
  • Physical therapy (8 visits)$960
  • Generic Rx$80
  • Brand Rx$80

High utilizer — surgery + ER

$17,730

Premium $8,880Medical $6,170Rx $2,680
Deductible engaged
  • Primary care visits$100
  • Specialist visits$330
  • ER visits$300
  • Outpatient surgery$5,200
  • Follow-up imaging$240
  • Generic Rx$120
  • Brand Rx$160
  • Specialty Rx (member share)$2,400