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Moda Health PPORX (PPO) benefits

The Moda Health PPORX plan features valuable medical and prescription drug benefits designed to help you manage your health. Some of the highlights of this plan include:

Medical benefits

  • Annual out-of-pocket maximum of $3,400 which includes both in- and out-of-network services
  • Low deductible of $100
  • Routine vision exam benefit once every two years
  • Access to any Medicare provider in- or out-of-network
  • Travel and visitor coverage for up to 12 months in the USA
  • Silver&Fit® Fitness Program
  • Worldwide coverage for emergency medical services

Prescription drug benefits

  • $120 annual deductible, after which you pay the following for up to a 31 day supply:
    • $2.00 copayment for Tier 1 preferred generic drugs
    • $20.00 copayment for Tier 2 generic drugs
    • $45.00 copayment for Tier 3 preferred brand drugs
    • $100.00 copayment for Tier 4 non-preferred brand drugs
    • 30% coinsurance for Tier 5 specialty drugs
  • When your total drug costs reach $3,750, you pay the following:
    • 44% of the plan's cost for all generic drugs and 35% of the plan's cost for brand-name drugs until your annual out-of-pocket drug costs reach the $5,000 Catastrophic coverage limit (out-of-pocket maximum)
  • After your annual out-of-pocket drug costs reach $5,000, you pay the greater of:
    • $3.35 for generic (including brand-name drugs treated as generic) and $8.35 for all other drugs
      OR
    • coinsurance of 5% of the cost of the drug

The Moda Health PPORX summary of benefits tells you some features of our plans. You can compare Moda Health PPO and Moda Health PPORX using this Summary of Benefits. The charts in this booklet list some important health benefits.

Our members receive all of the benefits that the Original Medicare plan offers. We also offer more benefits, which may change from year to year.

The Moda Health PPORX Evidence of Coverage includes details about plan benefits, limitations, restrictions, the appeal and grievance process and other important information. You may also call Moda Health member services and ask for the "Evidence of Coverage" or more information about plan benefits.

Silver&Fit®

With the Silver&Fit® program, you may choose to work out in a fitness facility or in the comfort of your own home with access to home fitness kits (up to 2 kits per benefit year).

The Silver&Fit® Program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit® is a registered trademark of ASH and used with permission herein. All programs and services may not be available in all areas.

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.

Last updated October 1, 2017
Y0115_WEB_2018A Approved

We're sorry, we don't currently offer Medicare plans in . View our plans in or use the dropdown at the top of the page to view Medicare plans in Oregon.

Moda Health PPORX (PPO) benefits

The Moda Health PPORX plan features valuable medical and prescription drug benefits designed to help you manage your health. Some of the highlights of this plan include:

Medical benefits

  • Annual out-of-pocket maximum of $3,400 which includes both in- and out-of-network services
  • Low deductible of $125
  • Routine vision exam benefit once every two years
  • Access to any Medicare provider in- or out-of-network
  • Travel and visitor coverage for up to 12 months in the USA
  • Silver&Fit® Fitness Program
  • Worldwide coverage for emergency medical services

Prescription drug benefits

  • $120 annual deductible, after which you pay the following for up to a 31 day supply:
    • $2.00 copayment for Tier 1 preferred generic drugs
    • $20.00 copayment for Tier 2 generic drugs
    • $45.00 copayment for Tier 3 preferred brand drugs
    • 50% coinsurance for Tier 4 non-preferred brand drugs
    • 30% coinsurance for Tier 5 specialty drugs
  • When your total drug costs reach $3,700, you pay the following:
    • 51% of the plan's cost for all generic drugs and 40% of the plan's cost for brand-name drugs until your annual out-of-pocket drug costs reach the $4,950 Catastrophic coverage limit (out-of-pocket maximum)
  • After your annual out-of-pocket drug costs reach $4,950, you pay the greater of:
    • $3.30 for generic (including brand-name drugs treated as generic) and $8.25 for all other drugs OR
      OR
    • coinsurance of 5% of the cost of the drug

The Moda Health PPORX summary of benefits tells you some features of our plans. You can compare Moda Health PPO and Moda Health PPORX using this Summary of Benefits. The charts in this booklet list some important health benefits.

Our members receive all of the benefits that the Original Medicare plan offers. We also offer more benefits, which may change from year to year.

The Moda Health PPORX Evidence of Coverage includes details about plan benefits, limitations, restrictions, the appeal and grievance process and other important information. You may also call Moda Health member services and ask for the "Evidence of Coverage" or more information about plan benefits.

Silver&Fit®

With the Silver&Fit® program, you may choose to work out in a fitness facility or in the comfort of your own home with access to home fitness kits (up to 2 kits per benefit year).

The Silver&Fit® Program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit® is a registered trademark of ASH and used with permission herein. All programs and services may not be available in all areas.

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.

Last updated October 1, 2016
Y0115_WEB_2017 Approved

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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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