Moda Be Aligned OR

Plan Information
Company Moda Health Plan
State OR
Metal Tier Silver
Plan Type PPO

Cost Sharing Benefits

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $2,500 $5,000
Deductible (Family) $5,000 $10,000
Coinsurance 35% 50%
Out of Pocket Maximum (Individual) $6,000 $12,000
Out of Pocket Maximum (Family) $12,000 $24,000
Services In Network Out of Network
Primary Care Visit First five visits 30 copay each, then 0.35 50% coinsurance
Specialist Visit 35% coinsurance 50% coinsurance
In Patient Hospital Services 35% coinsurance 50% coinsurance
Emergency Room Services 35% coinsurance 35% coinsurance
Mental / Behavioral Health 35% coinsurance 50% coinsurance
Imaging (CT/PET Scans, MRIs) 35% coinsurance 50% coinsurance
Rehabilitative Speech Therapy 35% coinsurance 50% coinsurance
Rehabilitative Occupational & Physical Therapy 35% coinsurance 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services 35% coinsurance 50% coinsurance
X-ray and Diagnostic Imaging 35% coinsurance 50% coinsurance
Outpatient Facility 35% coinsurance 50% coinsurance
Outpatient Surgery 35% coinsurance 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $10 copay
Preferred Brand Rx 50% coinsurance
Non Preferred Brand Rx 50% coinsurance
Specialty Drugs 0.5

Other Plans

Other plans that are available in the state.

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