Picking the right plan
Find your perfect fit
Health plans are personal. Knowing how much you’ll pay for your premium, deductibles, copays and coinsurance — and how much coverage you need — will help you choose the one that fits you best.
We offer a variety of individual and family medical and dental plans in Oregon and Alaska. Plans differ by how much they cost and how much they cover. Shop our plans to find your best match.
Medical plans fall into levels called metal categories: Gold, Silver and Bronze. Understanding these levels can help you choose the plan that’s right for you.
- Gold plans cost the most, but they cover about 80 percent of the total average cost of care.
- Silver plans sit somewhere in the middle, giving members a combination of coverage and value, with mid-range monthly premiums. These plans cover about 70 percent of the total average cost of care.
- Bronze plans give members less coverage – about 60 percent of the total average cost of care – but have lower monthly premiums.
Each plan level meets the requirements of the Affordable Care Act (ACA).
What affects your monthly premium?
A few things affect the amount you pay each month. The first is the plan you choose. Some plans simply cost more because they offer greater benefits.
The second is your age and the age of your dependents — your spouse or partner and/or children not older than 25. Your premium will go up a little each year until you turn age 65, when you’ll be eligible for Medicare. If you are covering children under age 21, they each have the same premium rate based on the plan. Child dependents age 21 through 25 have a rate based on their actual age.
Finally, the region — or rating area where you live — may also affect the cost of your plan’s premium.
Primary care providers
As a Moda Health member in Oregon, you’ll get personalized, coordinated care from your primary care provider (PCP) — a professional you select to help manage your healthcare. This provider works closely with Moda Health and the rest of your care team to help you achieve better health and wellness. Many in-network providers in your coverage area are available as PCPs. You can choose any of these, and you can always change to another in-network PCP later.
In Alaska, you can choose from 2 tiers of in-network providers in Alaska to get care.
Each Moda Health medical plan comes with a provider network. This is a group of licensed medical professionals, clinics, labs, pharmacies and hospitals that offer quality care and services to Moda Health members at an agreed-upon cost.
All 2021 Oregon medical plans are connected to an Exclusive Provider Organization (EPO) network. There are no out-of-network benefits with an EPO plan, except for medical emergency and retail pharmacy services or for children living out of state but in the U.S. with QMCSO or who are students age 18 to 26. Your healthcare provider and specialists must be in-network for the plan you choose, or you will be responsible for the full cost of out-of-network services.
All 2021 Alaska medical plans have a 3-tier network in the Pioneer network service area - Anchorage, Fairbanks North Star, Kenai Peninsula, Ketichikan Gateway and Mat-Su boroughs and Prince of Wales-Hyder Census Area. You can see any licensed provider in Alaska. Tier 1 has the lower deductible, out-of-pocket maximum, copay and coinsurance and Tier 3 has the highest member out-of-pocket cost.Explore our frequently asked questions (FAQs).
Our Delta Dental plans connect you with great benefits and quality in-network dentists in Oregon and Alaska. In some Delta Dental plans, preventive care is fully covered.
With each plan, you can count on:
- Savings from in-network or participating dentists
- Cleanings every six months
- Benefit estimates prior to treatment
- Superior customer service
Differences between the Delta Dental plans we offer include the per-person deductible amounts, the percentage members pay for covered services like fillings and space maintainers, and annual benefit maximums for members over the age of 19.
Delta Dental networks
Each Delta Dental plan comes with a Delta Dental network. It includes quality dentists across the state and the country.
In-network dentists have contracted with us to help get you the best rates. Using in-network and participating dentists can help you save on out-of-pocket costs. If you see nonparticipating providers or providers outside the network, you may pay more for care. If you choose the Delta Dental EPO plan, services provided out-of-network are not covered, except for emergency services.
You can enroll in a dental plan through the federal Marketplace at HealthCare.gov only if you are enrolling in a medical plan at the same time during an enrollment period.
Need more help with picking a dental plan?
Explore our frequently asked questions (FAQs).