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Moda Health HMO benefits

The Moda Health HMO 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 for in-network services
  • Low deductible of $85
  • Routine vision exam benefit once every year
  • 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:
    • $4.00 copayment for Tier 1 preferred generic drugs
    • $10.00 copayment for Tier 2 generic drugs
    • $45.00 copayment for Tier 3 preferred brand drugs
    • $95.00 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 HMO summary of benefits lists 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 HMO 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.

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.

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 a 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 your services.

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 HMO (HMO-POS )benefits

The Moda Health HMO (HMO-POS) 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 for in-network services
  • Low deductible of $110
  • Out-of-network services through the Point-of-Service (POS) benefit
  • Routine vision exam benefit once every two years
  • 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:
    • $4.00 copayment for Tier 1 preferred generic drugs
    • $10.00 copayment for Tier 2 generic drugs
    • $45.00 copayment for Tier 3 preferred brand drugs
    • $95.00 copayment 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
    • coinsurance of 5% of the cost of the drug

The Moda Health HMO (HMO-POS) summary of benefits lists 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 HMO (HMO-POS) 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.

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.

Last updated October 1, 2016
Y0115_WEB_2017A 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.

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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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