Moda Health HMO (HMO-POS)

Moda Health HMO is an HMO-POS plan with a Medicare contract. Enrollment in Moda Health HMO (HMO-POS) depends on contract renewal.

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Residents of Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler counties in Oregon may enroll on this plan.

If you're looking for a comprehensive Medicare Advantage HMO (HMO-POS) plan with prescription drug benefits, we are pleased to offer Moda Health HMO (HMO-POS). This plan was designed with both your medical and prescription drug needs in mind, offering excellent benefits that fit your lifestyle. With the Moda Health HMO (HMO-POS) plan, you will enjoy the following benefits:

  • Low monthly premiums, only $63 per month (You must continue to pay your Medicare Part B premium)
  • Low deductible of $110
  • Worldwide coverage for emergency services
  • Routine eye exam once every two years
  • Protection of an annual out-of-pocket maximum
  • Out-of-network services through the Point-of-Service (POS) benefit
  • Coordination of care services
  • Part D prescription drug coverage
Medical coverage Moda Health HMO (HMO-POS)
  In-network Out-of-network
Monthly health plan premium $63
Annual out-of-pocket maximum $3,400
Annual medical deductible $110
Primary care provider $25 copay $40 copay
Specialist office visit (4) $35 copay $50 copay
Inpatient hospital care (per stay) (1) (3) $300 per day for days 1 - 5 $400 per day for days 1 - 5
Outpatient surgery (per stay) (3) 20% hospital
or 10% ASC (2)
30% hospital
or 20% ASC (2)
Medicare-covered preventive services $0 copay
Lab services $0 copay
X-ray, CT, MRI, PET, etc. (3) 20% coinsurance 30% coinsurance
Routine vision exam every two years $35 copay

Moda Health Extra Care is available at an additional $12 premium per month and includes non-Medicare covered services such as chiropractic, naturopathic, acupuncture, hearing services and vision hardware. 50% coinsurance for services up to $500 maximum benefit per year.

(1) Unlimited hospital days; (2) Ambulatory Surgical Center (3) Prior authorization required (4) PCP referral required

Prescription drug plan Moda Health HMO (HMO-POS)
Deductible $120
Tier 1 (Preferred Generics) $4 copay (5)
Tier 2 (Generics) $10 copay (5)
Tier 3 (Preferred Brands) $45 copay (5)
Tier 4 (Non-preferred Brands) $95 copay (5)
Tier 5 (Specialty tier) 30% (5)

(5) 31-day supply

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

Out-of-network/non-contracted providers are under no obligation to treat Moda Health Plan, Inc. members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1-877-299-9062. This is a free service. To see this message in another language refer to Multi-language Interpreter Services notice

Last updated October 1, 2016
YY0115_WEB_2017A Approved

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Moda Health HMO

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

Together, we can be more, be better.

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