Moda Health. Healthcare from your head to your toes. Delta Dental | Moda Health

Moda Health PPO

Moda Health PPO is a PPO plan with a Medicare contract. Enrollment in Moda Health PPO depends on contract renewal.

Enrollment
Benefits
Premium
Provider network
Appeals and grievances
Disenrollment
Administrative information
Forms

This plan does not include Part D Prescription Drug Coverage.

Moda Health is proud to offer Medicare-eligible individuals our comprehensive PPO medical plan. This plan was designed with your medical needs in mind, offering excellent benefits that fit your lifestyle. With the Moda Health PPO plan, you'll enjoy:

  • A statewide network of more than 5,500 providers, plus the freedom to use out-of-network Medicare providers
  • No deductible
  • Worldwide coverage for emergency services
  • Protection of an annual out-of-pocket maximum
  • Routine eye exam once every two years
  • No referrals required
  • 12-month travel benefit within the United States
  • Silver&Fit® Fitness Program
  • Coordination of care services
Medical coverage Moda Health PPO
  In-network Out-of-network
Monthly health plan premium $16
Annual out-of-pocket maximum $3,400
Annual medical deductible $0
Primary care provider $20 copay
Specialist office visit $35 copay
Inpatient hospital care (per stay) (1) (3) $250 per day
for days 1-5
$350 per day for days 1 – 5
Outpatient surgery (per stay) (3) $200 hospital
or ASC (2)
$300 hospital
or ASC (2)
Medicare-covered preventive services $0 copay
Lab services $0 copay
X-ray, CT, MRI, PET, etc. (3) 20% coinsurance
Routine vision exam every two years $35 copay
Travel benefit in the U.S. 12 months
Silver&Fit® Fitness Program You must use a facility participating in the ASH Fitness network.
$0 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 applies for services up to a combined $500 maximum benefit per year.

(1) Unlimited hospital days; (2) Ambulatory Surgical Center (3) Prior authorization required in-network only

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, 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 PPO

Moda Health PPO is a PPO plan with a Medicare contract. Enrollment in Moda Health PPO depends on contract renewal.

This plan does not include Part D Prescription Drug Coverage.

Moda Health is proud to offer Medicare-eligible individuals our comprehensive PPO medical plan. This plan was designed with your medical needs in mind, offering excellent benefits that fit your lifestyle. With the Moda Health PPO plan, you'll enjoy:

  • A statewide network of more than 9,500 providers, plus the freedom to use out-of-network Medicare providers
  • No deductible
  • Worldwide coverage for emergency services
  • Protection of an annual out-of-pocket maximum
  • Routine eye exam once every two years
  • No referrals required
  • 12-month travel benefit within the United States
  • Silver&Fit® Fitness Program
  • Coordination of care services
Medical coverage Moda Health PPO
  In-network Out-of-network
Monthly health plan premium $16
Annual out-of-pocket maximum $3,400
Annual medical deductible $0
Primary care provider $20 copay
Specialist office visit $35 copay
Inpatient hospital care (per stay) (1) (3) $250 per day
for days 1-5
$350 per day for days 1 – 5
Outpatient surgery (per stay) (3) $200 hospital
or ASC (2)
$300 hospital
or ASC (2)
Medicare-covered preventive services $0 copay
Lab services $0 copay
X-ray, CT, MRI, PET, etc. (3) 20% coinsurance
Routine vision exam every two years $35 copay
Travel benefit in the U.S. 12 months
Silver&Fit® Fitness Program $0 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 applies for services up to a $500 maximum benefit per year.

(1) Unlimited hospital days; (2) Ambulatory Surgical Center (3) Prior authorization required in-network only

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.

Enrollment
Benefits
Premium
Provider network
Appeals and grievances
Disenrollment
Administrative information
Forms

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
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.

Moda Health Provider Network

Find a physician, pharmacy or clinic

Opt in for medical

Tell us you're interested and we'll be in touch with details.

Get Started  Get Started

Questions?

If you can't find an answer, please feel free to contact our Customer Service Customer Service Customer Service

Questions?

If you can't find an answer, please feel free to contact our Customer Service

Employer web tools

Benefit Tracker

Check benefits and eligibility

Log in

Account help

Request an account

Provider Reports

For value-based provider programs, including Synergy, Summit, Beacon, Affinity, CPC+, and EOCCO

Log in

Join our email list


Benefit Tracker

Check benefits, eligibility, incentive and utilization

Log In

Account help

Create an account

Producer web tools


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.

Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:

Hello.

Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:

Changing your location to Oregon

You can return to your previous location in the site header.