Moda Health PPO (PPO)

Oregon Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Moda Health Plan, Inc.

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.0
out of 5 stars

Ready to Enroll Online?


Plan Name
Moda Health PPO (PPO)
Insurance Carrier
Moda Health Plan, Inc.
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
PPO

Moda Health PPO (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Oregon and offered by the health insurance company Moda Health Plan, Inc.. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$4,500
Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit
ER visit
$90 copay per visit (always covered)
Ambulance
$225 copay

Moda Health PPO (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,500 In and Out-of-network $4,500 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Moda Health PPO (PPO) are defined below.

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Moda Health PPO (PPO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Moda Health PPO (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Moda Health PPO (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Moda Health PPO (PPO) received an overall government quality rating of 3.0 stars out of 5 stars.

Moda Health PPO (PPO) performed worse than Oregon’s State average overall quality score of 3.4 stars.

This Plan’s 5-star Gov’t Quality Score
Oregon State Average Score
Overall Government 5 Star Quality Rating
 3.0
 3.4
Summary rating of health plan quality
 3
 3.4
Staying healthy: screenings, tests, & vaccines
 4
 3.6
Managing chronic (long term) conditions
 3
 3.3
Member experience with health plan
 2
 3.0
Member complaints & changes in the health plan's performance
 4
 3.9
Health plan customer service
 4
 4.1

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Moda Health PPO (PPO) received 3 stars for its health plan quality score which is worse than the Oregon State average health plan quality score of 3.4 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$4,500 In and Out-of-network
$4,500 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $20 copay per visit
Specialist visit
In-network: $35 copay per visit
Out-of-network: $35 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Lab services
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Emergency care
$90 copay per visit (always covered)
Urgent care
$35 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $325 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $425 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
In-network: $225 copay per visit
Out-of-network: $325 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$160 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$160 per day for days 21 through 100

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: 30% coinsurance

Ambulance

Ground ambulance
In-network: $225 copay
Out-of-network: $225 copay

Therapy services

Occupational therapy visit
In-network: $35 copay
Out-of-network: $35 copay
Physical therapy & speech & language therapy visit
In-network: $35 copay
Out-of-network: $35 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $35 copay
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $35 copay
Outpatient group therapy visit
In-network: $35 copay
Out-of-network: $35 copay
Outpatient individual therapy visit
In-network: $35 copay
Out-of-network: $35 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 30% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance

Hearing

Hearing exam
In-network: $35 copay
Out-of-network: $35 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $699-999 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Non-routine services
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Diagnostic services
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Restorative services
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Endodontics
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Periodontics
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Extractions
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: 20% coinsurance
Out-of-network: 50% coinsurance

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
In-network: $0 copay
Out-of-network: 0-50% coinsurance

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Ready to Enroll Online?

Please Support Our Sponsor

Advertisement

Medicare Health Plans

Get Advice & Sign Up Help

TTY 711

Speak with a Licensed Insurance Agent

Mon-Fri: 8am - 11pm ET
Sat-Sun: 8am - 11pm ET

Medicare65quote

  • Medicare Advantage Plans
  • Medicare Prescription Drug Plans
  • Medicare Supplement Insurance Plans

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! See www.medicare65quote.com for our Third-Party Marketing Organization disclaimer.

Related Articles
Best Oregon Medicare Advantage Health Insurance Companies for 2024

In this article we rank Oregon Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

Read more →