Moda Health PPORX (PPO)

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

Enrollment
Benefits
Premium
Medical provider network
Pharmacy information
Appeals and grievances
Disenrollment
Administrative information
Forms

If you're looking for a comprehensive Medicare Advantage PPO plan with prescription drug benefits, we are pleased to offer Moda Health PPORX. 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 PPORX plan, you'll enjoy the following benefits:

  • A statewide network of more than 5,500 providers, plus the freedom to use out-of-network Medicare providers
  • Low deductible of $100
  • 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
  • Part D prescription drug coverage
Medical coverage Moda Health PPORX (PPO)
  In-network Out-of-network
Monthly health plan premium $119.00
Annual out-of-pocket maximum $3,400
Annual medical deductible $100
Primary care provider $25 copay $40 copay
Specialist office visit $35 copay $50 copay
Inpatient hospital care (per stay) (1) (3) $295 per day
for days 1-5
$400 per day for days 1-5
Outpatient surgery (per stay) (3) $295 hospital
or ASC (2)
30% of the cost for hospital
or 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
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 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

Prescription drug plan Moda Health PPORX (PPO)
Deductible $120
Tier 1 (Preferred Generics) $2 copay(4)
Tier 2 (Generics) $20 copay(4)
Tier 3 (Preferred Brands) $45 copay(4)
Tier 4 (Non-preferred Brands) $100 copay(4)
Tier 5 (Specialty tier) 30%(4)
(4) 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, 2017
Y0115_WEB_2018A Pending

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)

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

If you're looking for a comprehensive Medicare Advantage PPO plan with prescription drug benefits, we are pleased to offer Moda Health PPORX. 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 PPORX plan, you'll enjoy the following benefits:

  • A statewide network of more than 9,500 providers, plus the freedom to use out-of-network Medicare providers
  • Low deductible of $125
  • 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
  • Part D prescription drug coverage
Medical coverage Moda Health PPORX (PPO)
  In-network Out-of-network
Monthly health plan premium $98.00
Annual out-of-pocket maximum $3,400
Annual medical deductible $125
Primary care provider $25 copay $40 copay
Specialist office visit $35 copay $50 copay
Inpatient hospital care (per stay) (1) (3) $295 per day
for days 1-5
$400 per day for days 1-5
Outpatient surgery (per stay) (3) $295 hospital
or ASC (2)
30% of the cost for hospital
or 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
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 for services up to $500 maximum benefit per year.

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

Prescription drug plan Moda Health PPORX (PPO)
Deductible $120
Tier 1 (Preferred Generics) $2 copay(4)
Tier 2 (Generics) $20 copay(4)
Tier 3 (Preferred Brands) $45 copay(4)
Tier 4 (Non-preferred Brands) 50%(4)
Tier 5 (Specialty tier) 30%(4)
(4) 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.

Enrollment
Benefits
Premium
Medical provider network
Pharmacy information
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.

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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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