Moda Health PPORX (PPO) By MODA Health Plan, Inc.
Moda Health PPORX (PPO) is a 2015 Medicare Advantage ("Part C" or "MA Plan") plan by MODA Health Plan, Inc.. This plan from MODA Health Plan, Inc. works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Moda Health PPORX (PPO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from MODA Health Plan, Inc. and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2015 Medicare Advantage Plan Details
Moda Health PPORX (PPO)
|Provider:||MODA Health Plan, Inc.|
|Plan Type:||Local PPO|
|Monthly Premium C+D:||$70.00|
Coverage Area for Moda Health PPORX (PPO)
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The Moda Health PPORX (PPO) H3813-006 is available to residents in Oregon, and has a in-network Maximum Out-of-Pocket limit of $3,400 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Moda Health PPORX (PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $3,400 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.
Moda Health PPORX (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.
Ratings for Moda Health PPORX (PPO) H3813
|2015 Overall Rating|
|Part C Summary Rating|
|Part D Summary Rating|
|Staying Healthy: Screenings, Tests, Vaccines|
|Managing Chronic (Long Term) Conditions|
|Member Experience with Health Plan|
|Complaints and Changes in Plans Performance|
|Health Plan Customer Service|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Member Experience with Health Plan
|Total Experience Rating|
|Getting Needed Care|
|Timely Care and Appointments|
|Health Care Quality|
|Rating of Health Plan|
Member Complaints and Changes in Moda Health PPORX (PPO) Plans Performance
|Members Leaving the Plan|
|Complaints about Health Plan|
|Health Plan Quality Improvement|
Health Plan Customer Service Rating for Moda Health PPORX (PPO)
|Total Customer Service Rating|
|Timely Decisions About Appeals|
|Reviewing Appeals Decisions|
Staying Healthy, Screening, Testing, & Vaccines
|Total Preventative Rating|
|Breast Cancer Screening|
|Colorectal Cancel Screening|
|Annual Flu Vaccine|
|Improving Mental Health|
|Monitoring Physical Activity|
|Adult BMI Assessment|
Ratings For Managing Chronic And Long Term Care
|SNP Care Management|
|Functional Status Assessment|
|Diabetes Care - Eye Exam|
|Diabetes Care - Kidney Disease|
|Diabetes Care - Blood Sugar|
|Diabetes Care - Cholesterol|
|Controlling Blood Pressure|
|Improving Bladder Control|
|Reducing Risk of Falling|
|Plan - Cause Readmissions|
Ratings For Member Experience with the Drug Plan
|Rating of Drug Plan|
|Getting Needed Prescription Drugs|
Drug Safety and Accuracy of Drug Pricing
|MPF Price Accuracy|
|High Risk Medication|
|Drug Adherence for Diabetes Medications|
|Drug Adherence for Hypertension (RAS antagonists)|
|Drug Adherence for Cholesterol (Statins)|
Ratings For Member Complaints and Changes in the Drug Plans Performance
|Complaints about the Drug Plan|
|Members Choosing to Leave the Plan|
|Drug Plan Quality Improvement|
Moda Health PPORX (PPO) Drug Plan Customer Service ratings
|Appeals Auto Forward|
MODA Health Plan, Inc. plan charges a $5.10 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The Moda Health PPORX (PPO) plan has a monthly drug premium of $64.90 and a $120.00 drug deductible. This MODA Health Plan, Inc. plan offers a $64.90 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by MODA Health Plan, Inc. above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $64.90. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Moda Health PPORX (PPO) medicare insurance plan offers a $31.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $39.50 for 75% low income subsidy $48.00 for 50% and $56.40 for 25%.
|Part C Premium:||$5.10|
|Part D (Drug) Premium:||$64.90|
|Part D Supplemental Premium||$0.00|
|Total Part D Premium:||$64.90|
|Tiers with No Deductible:||0|
|Benchmark:||not below the regional benchmark|
|Type of Medicare Health Plan:||Enhanced Alternative|
|Drug Benefit Type:||Enhanced|
|Full LIS Premium:||$31.10|
|75% LIS Premium:||$39.50|
|50% LIS Premium:||$48.00|
|25% LIS Premium:||$56.40|
|Inital Coverage Limit:||$2960|
In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs. Once you reach the coverage gap you will pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. This MODA Health Plan, Inc. plan does not offer additional coverage through the gap.
Plans as of September 2, 2014.
Star Rating as of Oct 3, 2014.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change. All contracts for 2015 have been finalized. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit
Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.