2022 Moda Health PPO (PPO)

Moda Health PPO (PPO) H3813-001 is a 2022 Medicare Advantage Plan or Part-C by Moda Health Plan, Inc available to residents in Oregon. This plan does not provide additional prescription drug (Part-D) coverage. The Moda Health PPO (PPO) has a monthly premium of $15.00 and has an in-network maximum out-of-pocket limit of $3,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,500 out-of-pocket. This can be a extremely nice safety net.

Moda Health PPO (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Moda Health Plan, Inc works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Moda Health PPO (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Moda Health Plan, Inc and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Moda Health Plan, Inc except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

2022 Moda Health Plan, Inc Medicare Advantage Plan Costs

2021 Moda Health PPO (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

---

Additional Benefits

No

---

Comprehensive Dental

Diagnostic services	$0 copay
Diagnostic services	$0 copay (Out-of-Network)
Endodontics	$0 copay (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay
Extractions	$0 copay (Out-of-Network)
Non-routine services	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Periodontics	$0 copay (Out-of-Network)
Periodontics	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Restorative services	$0 copay
Restorative services	$0 copay (Out-of-Network)

---

Deductible

$0

---

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0 copay (Out-of-Network)
Diagnostic tests and procedures	$0 copay
Lab services	$0 copay
Lab services	$0 copay (Out-of-Network)
Outpatient x-rays	20% coinsurance
Outpatient x-rays	30% coinsurance (Out-of-Network)

---

Doctor Visits

Primary	$15 copay per visit
Primary	$15-35 copay per visit (Out-of-Network)
Specialist	$35 copay per visit (Out-of-Network)
Specialist	$35 copay per visit

---

Emergency care/Urgent Care

Emergency	$65 copay per visit (always covered)
Urgent care	$35 copay per visit (always covered)

---

Foot Care (podiatry services)

Foot exams and treatment	$35 copay
Foot exams and treatment	$35 copay (Out-of-Network)
Routine foot care	Not covered

---

Ground Ambulance

$100 copay
$100 copay (Out-of-Network)

---

Hearing

Fitting/evaluation	Not covered
Hearing aids	$0 copay (Out-of-Network)
Hearing aids	$699-999 copay
Hearing exam	$25 copay
Hearing exam	$25 copay (Out-of-Network)

---

Inpatient Hospital Coverage

$250 per day for days 1 through 5 $0 per day for days 6 through 90
$350 per day for days 1 through 5 $0 per day for days 6 and beyond (Out-of-Network)

---

Medical Equipment/Supplies

Diabetes supplies	$0 copay
Diabetes supplies	0-25% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	25% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	25% coinsurance per item (Out-of-Network)

---

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	25% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	25% coinsurance (Out-of-Network)

---

Mental Health Services

Inpatient hospital - psychiatric	$250 per day for days 1 through 5 $0 per day for days 6 through 90
Inpatient hospital - psychiatric	$350 per day for days 1 through 5 $0 per day for days 6 through 190 (Out-of-Network)
Outpatient group therapy visit	$35 copay (Out-of-Network)
Outpatient group therapy visit	$20 copay
Outpatient group therapy visit with a psychiatrist	$35 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$20 copay
Outpatient individual therapy visit	$20 copay
Outpatient individual therapy visit	$35 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$35 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$20 copay

---

MOOP

$3,500 In and Out-of-network $3,500 In-network

---

Option

No

---

Optional supplemental benefits

Yes

---

Outpatient Hospital Coverage

$300 copay per visit (Out-of-Network)
$200 copay per visit

---

Package #1

Deductible
Monthly Premium	$5.00

---

Preventive Care

30% coinsurance (Out-of-Network)
$0 copay

---

Preventive Dental

Cleaning	$0 copay (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Oral exam	$0 copay
Oral exam	$0 copay (Out-of-Network)

---

Rehabilitation Services

Occupational therapy visit	$35 copay
Occupational therapy visit	$35 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$35 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$35 copay

---

Skilled Nursing Facility

$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

---

Transportation

Not covered

---

Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$0 copay (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

---

Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Moda Health PPO (PPO) H3813

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Moda Health PPO (PPO) Plans Performance

Health Plan Customer Service Rating for Moda Health PPO (PPO)

Moda Health PPO (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Moda Health PPO (PPO)

(Click county to compare all available Advantage plans)

Go to top

Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.