2019 Plan Changes. Moda Health
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- Rosalind Harris
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1 Moda Health v
2 Moda Health 2019 Plan Changes Medicare - Supplement The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100 PERS Moda Health PPORX (PPO) Medicare Advantage This plan is no longer available Non-Medicare The Core Value and Select Value plans are no longer available ID Cards New ID cards will be issued for 2019
3 Moda Health and Delta Dental Enrollment Service Area Nationwide Moda Health Medicare Supplement Plan Delta Dental of Oregon
4 The Value of Moda Health and the PHIP Partnership Enhanced Medicare Part D prescription coverage Comprehensive dental plan Delta Dental of Oregon Moda Health Medicare Supplement medical plan: Nationwide coverage Members can live anywhere in the U.S. and access any Medicare provider Member generally pays nothing after Part B deductible is met Medicare pays 80%, Moda pays 20% for Medicare covered services
5 Moda Health Medicare Supplement Plan
6 Moda Health Medicare Supplement How Our Plan Works Choose any Medicare doctor, specialist or hospital Doctor/facility bills Original Medicare Original Medicare bills remaining balance to Moda Health Virtually no paperwork
7 Moda Health Medicare Supplement Benefit Coverage Deductible Medical Out-of-Pocket Maximum Primary Care Office Visit Specialist Office Visit Inpatient Hospitalization Outpatient Surgery Lab Tests X-ray Pharmacy Pharmacy Out-of-Pocket Maximum Member Responsibility $183 per individual* N/A Covered in full 40% of charge up to $250 maximum per 31-day supply $5,100 per individual *Part B deductible, required by Medicare, listed is for 2018.
8 Moda Health Medicare Supplement After Medicare Part B deductible has been met Medicare provider accepting assignment Billed amount $150 Medicare allows $100 Limiting charge (15%) N/A Provider write-off $50 Medicare pays 80% $80 Moda Health pays 20% $20 Patient owes $0 Medicare provider NOT accepting assignment $150 $100 $115 $35 $80 $20 $15 Non- Medicare provider $150 N/A N/A $0 $0 $0 $150
9 Moda Health Medicare Supplement Emergency and Travel Benefits Urgent Care MEMBER PAYS: Emergency Room Covered in full after deductible anywhere in U.S. Ambulance - ground or air Outside of the United States Covers urgent care, ER and ambulance at 80% coinsurance. The member will pay 20% coinsurance. Coverage limited to $50,000 per member (lifetime)
10 Moda Health Special Attributes Personal assistance Nurse care coordinators Medical case managers Health coaching programs Phone resources Local customer service; based in Oregon Calls answered in 30 seconds Customer service hours are 7:00 am 8:00 pm, Monday Friday Online resources Dedicated PERS website at Benefit specific detail mymoda Claims information Find Care Value added services and discounts
11 Moda Health Discount Services VSP Discounts on eye exams, frames, lenses and contacts TruHearing Choice Discounts on hearing aids and hearing tests ChooseHealthy Program Discounts on: Massage therapy Chiropractic Acupuncture
12 Member Care Resources on 24-hour Registered Nurse Advice Line Available 24 hours a day 7 days a week edoc a health expert Cost-estimating tools Pharmacy Prescription price check, prescription history, and drug information Dental Dental cost estimator tool
13 Mobile ID Card App Moda Health ecard app allows you to or fax a copy of your ID card
14 Exercise & Healthy Aging Program Your Membership Includes*: Membership at a participating fitness center or 2 Home Fitness Program kits per year For more information and locations visit
15 Moda Health Part D Prescription Drug Plan
16 Pharmacy Network Benefit Moda PHIP Formulary Covers a comprehensive list of covered medications available online at MTM Program Medication Therapy Management (MTM) program included for Medicare members Free 1:1 comprehensive personalized medication review Local pharmacy customer service available 7:00 am 8:00 pm, Monday Friday Over 71,000 participating pharmacies nationwide Participating Pharmacies* Mail Order Pharmacies* Bi-Mart Costco CVS Pharmacy Fred Meyer/Kroger/QFC Rite Aid Safeway Walgreens Walmart Costco Postal Prescription Services Walgreens Mail Service Walmart Mail Service * Not all contracted network pharmacies are listed. Pharmacies contracted with Moda may change at any time. Moda will notify you if your pharmacy is no longer included in the network. Contact pharmacy customer service for more details.
17 Delta Dental of Oregon
18 Delta Dental of Oregon How Our Plan Works Who are we? We started providing dental coverage in 1955 as ODS What can you expect? Flexibility 4 out of 5 of the nation s dentists participate in our Premier and PPO networks Savings on dental procedures No balance billing
19 Delta Dental of Oregon Calendar Year Deductible.$25 Calendar Year Benefit Maximum..$1,500 Preventive..100%* Basic.80% Major.50% * Deductible waived for preventive services. Preventive charges do not accumulate to calendar year benefit maximum
20 Delta Dental of Oregon Additional Dental Benefits: Oral Health Total Health Program* Additional cleanings available if you are diabetic or in your third trimester of pregnancy 4 Periodontal maintenance cleanings per calendar year for members with periodontal disease* * Call our customer service for more information
21 Delta Dental of Oregon Access to the Delta Dental Premier and PPO National Networks More than 154,000 participating providers nationwide Passport Dental program - worldwide dental care
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