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Moda Health PPORX (PPO) premium

The Moda Health PPORX monthly premium for 2018 is $119.00. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

Payment options

Monthly payments may be made:

  • Directly to Moda Health. Please make checks payable to Moda Health Plan, Inc.
  • Through Electronic Funds Transfer (EFT) from your bank. Paying your premium through EFT ensures that your payment is always on time and frees you from the burden of mailing a monthly check.
  • View and pay your premium online using Moda Health eBill. You may access eBill by logging in or creating your myModa account.
  • Deducted from your monthly Social Security or Railroad R006_EFT form CY2018etirement Board (RRB) benefit check. (The Social Security/RRB deduction may take two or more months to begin after Social Security or RRB approves the deduction. In most cases, if Social Security or RRB accepts your request for automatic deduction, the first deduction from your Social Security or RRB benefit check will include all premiums due from your enrollment effective date up to the point withholding begins. If Social Security or RRB does not approve your request for automatic deduction, we will send you a paper bill for your monthly premiums.)

If you would like more information on deducting your monthly premium from your Social Security or Railroad Retirement Board benefit check, please contact member services.

Moda Health PPORX Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan.

This table shows you what your monthly plan premium will be if you get extra help.

Extra Help
Your level of extra help Monthly premium for Moda Health PPORX*
100% $84.40*
75% $93.10*
50% $101.70*
25% $110.40*

*This does not include any Medicare Part B premium you may have to pay.

Low-income subsidy

If you are receiving extra help from Medicare to pay for your prescription drugs and you will qualify for the same amount of help next year, the table below tells you how your prescription costs will change.

Cost Changes
If you paid this much in 2017 You will pay this much in 2018
$0 deductible $0 deductible
$82 deductible $83 deductible
$1.20 for generics and brands that are treated as generics $1.25 for generics and brands that are treated as generics
$3.70 for brand-name drugs $3.70 for brand-name drugs
$3.30 for generics and brands that are treated as generics $3.35 for generics and brands that are treated as generics
$8.25 for brand-name drugs $8.35 for brand-name drugs
15% coinsurance for all drugs 15% coinsurance for all drugs

The Moda Health PPORX premium includes coverage for both medical services and prescription drug coverage.

You may receive a letter from Medicare or the Social Security Administration about your eligibility for extra help in 2018. Read this important information carefully. If you don't know what level of extra help you qualify for, you can call 1-800-MEDICARE (1-800-633-4227, TTY: 1-877-486-2048). Representatives are available 24 hours a day, seven days a week.

If you aren’t getting extra help, you can see if you qualify by calling:

  • The Social Security Administration at 1-800-772-1213 (TTY users call 1-800-325-0778) between 7 a.m. and 7 p.m., seven days a week
  • Your state Medicaid office
  • 1-800-MEDICARE (1-800-633-4227), (TTY users call 1-877-486-2048) 24 hours a day seven days a week

If you have any questions, please contact member services.

Best available evidence (BAE)

Beneficiaries are “deemed” eligible for a low-income subsidy (LIS) if they are full-benefit Medicare/Medicaid-eligible, partial dual eligible, are receiving Social Security Income (SSI) or have applied and been awarded LIS by the Social Security Administration. There is a process for assisting individuals who do not have the required pieces of evidence but claim to be eligible for LIS. If you do not have the required evidence called “best available evidence” (BAE) and believe you are LIS-eligible, please call member services.

For more information, visit the section of the Centers for Medicare and Medicaid Services website regarding BAE policy.

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) premium

The Moda Health PPORX monthly premium for 2017 is $98.00. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

Payment options

Monthly payments may be made:

  • Directly to Moda Health. Please make checks payable to Moda Health Plan, Inc.
  • Through Electronic Funds Transfer (EFT) from your bank. Paying your premium through EFT ensures that your payment is always on time and frees you from the burden of mailing a monthly check.
  • View and pay your premium online using Moda Health eBill. You may access eBill by logging in or creating your myModa account.
  • Deducted from your monthly Social Security or Railroad Retirement Board (RRB) benefit check. (The Social Security/RRB deduction may take two or more months to begin after Social Security or RRB approves the deduction. In most cases, if Social Security or RRB accepts your request for automatic deduction, the first deduction from your Social Security or RRB benefit check will include all premiums due from your enrollment effective date up to the point withholding begins. If Social Security or RRB does not approve your request for automatic deduction, we will send you a paper bill for your monthly premiums.)

If you would like more information on deducting your monthly premium from your Social Security or Railroad Benefit Board benefit check, please contact member services.

Moda Health PPORX Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs

If you get extra help from Medicare to help pay for your prescription drug plan costs, your monthly plan premium will be lower than it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan.

This table shows you what your monthly plan premium will be if you get extra help.

Extra Help
Your level of extra help Monthly premium for Moda Health PPORX*
100% $63.20*
75% $71.90*
50% $80.60*
25% $89.30*

*This does not include any Medicare Part B premium you may have to pay.

Low-income subsidy

If you are receiving extra help from Medicare to pay for your prescription drugs and you will qualify for the same amount of help next year, the table below tells you how your prescription costs will change.

Cost Changes
If you paid this much in 2016 You will pay this much in 2017
$0 deductible $0 deductible
$74 deductible $82 deductible
$1.20 for generics and brands that are treated as generics $1.20 for generics and brands that are treated as generics
$3.60 for brand-name drugs $3.70 for brand-name drugs
$2.95 for generics and brands that are treated as generics $2.00 for generics and brands that are treated as generics
$7.40 for brand-name drugs $8.25 for brand-name drugs
15% coinsurance for all drugs 15% coinsurance for all drugs

The Moda Health PPORX premium includes coverage for both medical services and prescription drug coverage.

You may receive a letter from Medicare or the Social Security Administration about your eligibility for extra help in 2016. Read this important information carefully. If you don't know what level of extra help you qualify for, you can call 1-800-MEDICARE (1-800-633-4227, TTY: 1-877-486-2048). Representatives are available 24 hours a day, seven days a week.

If you aren’t getting extra help, you can see if you qualify by calling:

  • The Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778 between 7 a.m. and 7 p.m., seven days a week)
  • Your state Medicaid office
  • 1-800-MEDICARE (1-800-633-4227, TTY: 1-877-486-2048)

If you have any questions, please contact member services.

Best available evidence (BAE)

Beneficiaries are “deemed” eligible for a low-income subsidy (LIS) if they are full-benefit Medicare/Medicaid-eligible, partial dual eligible, are receiving Social Security Income (SSI) or have applied and been awarded LIS by the Social Security Administration. There is a process for assisting individuals who do not have the required pieces of evidence but claim to be eligible for LIS. If you do not have the required evidence called “best available evidence” (BAE) and believe you are LIS-eligible, please call member services.

For more information, visit the section of the Centers for Medicare and Medicaid Services website regarding BAE policy.

Last updated October 1, 2016
Y0115_WEB_2017A Approved

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