Moda Health PPO (PPO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by Moda Health Plan, Inc.
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 3.0
out of 5 stars

State: Oregon

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$18
$18
$0
$0
$3,500 In and Out-of-network
$3,500 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $15 copay per visit
Out-of-network: $15-35 copay per visit
In-network: $35 copay per visit
Out-of-network: $35 copay per visit

Tests, labs, & imaging

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
$65 copay per visit (always covered)
$35 copay per visit (always covered)

Hospital Services

In-network: $250 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $350 per day for days 1 through 5
$0 per day for days 6 and beyond
In-network: $200 copay per visit
Out-of-network: $300 copay per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$150 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$150 per day for days 21 through 100

Preventive services

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

Ambulance

In-network: $100 copay
Out-of-network: $100 copay

Therapy services

In-network: $35 copay
Out-of-network: $35 copay
In-network: $35 copay
Out-of-network: $35 copay

Mental health services

In-network: $20 copay
Out-of-network: $35 copay
In-network: $20 copay
Out-of-network: $35 copay
In-network: $20 copay
Out-of-network: $35 copay
In-network: $20 copay
Out-of-network: $35 copay

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item
In-network: $0 copay
Out-of-network: 0-25% coinsurance per item

Prescription Drug Benefits

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

Part B Drugs

In-network: 20% coinsurance
Out-of-network: 25% coinsurance
In-network: 20% coinsurance
Out-of-network: 25% coinsurance

Extra Benefits

Hearing

In-network: $25 copay
Out-of-network: $25 copay
Not covered
In-network: $699-999 copay
Out-of-network: $0 copay

Preventive Dental

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Vision

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
In-network: $0 copay
Out-of-network: $0 copay

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
 3.5
 4
 4
 3
 4
 3

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