2018 Moda Health HMO (HMO) H8506-1-0 in OR from Moda Health | HealthPocket

Moda Health HMO (HMO)

$1,092/mo

Apply For This Plan

Zip Code97229
Applicant11/20/1983 Male
Coverage Start11/22/2018
Apply Now

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderModa Health
Plan IDH8506-1-0
Plan Year2018
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$120.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In-network
Other health plan deductibles?No
Health Plan Deductible$85 In-network
Monthly Drug Plan Premium$46.60
Monthly Health Plan Premium$44.40

Benefits

SERVICECOST
Inpatient hospital coverage$300 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage20% per visit
Doctor visitsPrimary:
$25 per visit
Specialist:
$35 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:
$65 per visit (always covered)
Urgent care:
$35 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
$0 copay
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
20%
Outpatient x-rays:
20%
Mental health services$300 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$25
Outpatient individual therapy visit with a psychiatrist:
$25
Outpatient group therapy visit:
$25
Outpatient individual therapy visit:
$25
Skilled Nursing Facility$0 for days 1 through 20
$100 for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
$35
Physical therapy and speech and language therapy visit:
$35
Ambulance$250
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
$35
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 per item
Wellness programs (e.g., fitness, nursing hotline)Not covered
Medicare Part B drugsChemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Moda Health HMO (HMO)

StateOregon
CountyMultnomah

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$4 copayNot offered
Tier 2: Non-Preferred GenericNot offered$10 copayNot offered
Tier 3: Preferred Brand NameNot offered$45 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$95 copayNot offered
Tier 5: Specialty TierNot offered30% coinsuranceNot offered

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$8 copayNot offered
Tier 2: Non-Preferred GenericNot offered$20 copayNot offered
Tier 3: Preferred Brand NameNot offered$90 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$190 copayNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$12 copayNot offered
Tier 2: Non-Preferred GenericNot offered$30 copayNot offered
Tier 3: Preferred Brand NameNot offered$135 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$285 copayNot offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screeningNot Rated
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical abilityNot Rated
Adult BMI assessmentNot Rated

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye examNot Rated
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Controlling blood pressureNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Beneficiary access and performance problemsNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetes
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept Moda Health HMO (HMO) for Oregon

/
Please select the correct zip

No results found. Try changing the search distance or zip code.

HumanaChoice H5216-046 (PPO)
COST:from $0CMS Rating:
Select
ATRIO Bronze (PPO)
COST:from $0CMS Rating:
Select
FamilyCare Advantage Rx (HMO)
COST:from $0CMS Rating:
Select
AARP MedicareComplete Plan 2 (HMO)
COST:from $0CMS Rating:
Select
Health Net Violet 3 (PPO)
COST:from $0CMS Rating:Not Rated
Select

get free advice

Speak With A Licensed Agent

Call (800) 931-6467

Learn More

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.