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Moda Health Plans 2014

2015 Enrollment Application "Click to download"

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Oregon

2015 Enrollment Application "Click to download"

Rates Starting January 1st, 2015 for all plans offered.

Review all our medical and dental plans in Oregon:
2015 Oregon individual and family plans brochure

Medical plan summaries
Dental plan summaries

 

Rate Sheet for all Plans "pdf" January 1st, 2014

Full Brochure with Plans and Rates "Detailed" 2014 Year

The following plan description below reflect the 2014 year Plans.

Dental Plan Brochure & Rates    Dental Application

 

Gold Plans
Gold Be Protected 750 Deductible  Full SBC Plan Description Protected
Gold Be Focused 500 Deductible
Gold Be Focused-Rose City 500 Deductible
Gold Oregon Standard Gold 1300 Deductible
Silver Plans
Silver Be Prepared 1000 Deductible  Full SBC Plan Description Prepared
Silver Be Smart 3000 Deductible
Silver Be Aligned 2500 Deductible
Silver Be Aligned-Rose City 2500 Deductible
Silver Oregon Standard Silver 2500 Deductible  Full SBC Plan Description Standard Silver
Bronze Plans
Bronze Be Connected 4250 Deductible
Bronze Be Connected-Rose City 4250 Deductible
Bronze Be Savvy 5250 Deductible "HSA Qualified"  Full SBC Plan Description "HSA Be Savvy"
Bronze Oregon Standard Bronze 5000 Deductible    Full SBC Plan Description Standard Bronze
Dental Plans
Delta Dental Preferred (PPO) Delta Dental Exclusive (EPO)& Rates
Moda Dental Application 2014

Why choose Moda Health plans?

What health plans cover

Your way to better health

Health plans make it easier to get well sooner and stay healthy longer. That’s partly because they cover part of the costs of the care you receive.

That might include a doctor visit, hospital stay, preventive services, prescriptions drugs, mental health treatment or even physical therapy.

Many plans also come with extras, like free health coaching, fitness tips and a nurse advice line. For example, Moda Health plans include all of these resources, plus lots more. Members can access them by logging in to myModa from their desktop or mobile device.

What plans cover

When you buy a health plan, the coverage company, like Moda Health, pays part of your medical costs if you get sick or hurt. Some plans cover nearly all of your care up to a certain dollar amount. Other plans kick in only after you meet your deductible.

Most Moda Health plans include free preventive care. That covers women’s annual exams, well-baby care, routine physicals, immunizations and more. Benefit amounts vary for other types of care and procedures. And, after you meet your out of pocket maximum, care is covered at 100 percent, up to what your plan allows.

You are responsible for paying some costs as well, such as:

  • Premium – Your monthly cost for your plan.
  • Deductible – The amount you pay before the plan starts to cover most services beyond preventive care.
  • Copayment (copay) – A set dollar amount you pay for a service, like a doctor’s appointment.
  • Coinsurance – The percentage of a medical bill you pay, usually after you meet your deductible. You’ll pay either coinsurance or a copay for a service, but not both at the same time.
  • Out-of-pocket maximum – The total amount you could pay for covered services each year. After reaching your out-of-pocket maximum, plans pay 100 percent for the rest of your eligible healthcare expenses, up to what your plan allows.

 

How Health Care Reform affects you

How will your health insurance change?

You’ve probably heard the news. The health insurance industry is changing. Those changes are all part of “Health Care Reform.” You may wonder how it affects you. It’s different for everyone.

Whatever your situation, health reform brings new rights and protections. Those include more choice and control over your health coverage.

Where to find your health coverage

If you get health benefits through your job, your health plan may change. Just check with your group administrator to learn more. If you have your own individual coverage, you may need to re-enroll. Or, you can buy a new health plan. Explore Moda Health plans to get started.

For those who don’t have health insurance, you’ll need to follow a new federal law, which requires everyone have health coverage. Never fear — Moda Health can make that part easy.

What you need to know about the new healthcare law

  • The Affordable Care Act is a federal law designed to make it easier for you to get medical care. If you don’t already have health insurance, you’ll probably need to buy it starting in 2014 or face a fine. You can enroll in a new individual and family plan starting Oct. 1, 2013.
  • If you do need to buy health coverage and live in Oregon, Alaska or Washington, explore Moda Health plans here. You can also shop for plans on the health insurance marketplace.
  • You may be able to get help paying for your health insurance. Learn about qualifying for the federal tax credit. If you do qualify for a tax credit and want to use it, you must apply for your plan on the marketplace.

 

Special enrollment

How do you qualify?

Certain life events might qualify you for special enrollment. This means you can enroll for a health plan outside of the open enrollment period. For example, having a baby or moving to a new state could make you or those you cover eligible.

If you enrolled through Washington Healthplanfinder and have had issues with your 2014 health plan, you may be able to enroll in one of our 2014 plans. This temporary special enrollment period runs Aug. 27, 2014, through Nov. 14, 2014, in Washington.

Applying is easy

If you are a current member and think you qualify for regular special enrollment, please contact us. Just call toll-free at 877-605-3229 or email indunit@modahealth.com.

New to Moda Health? Explore our plans here and see if you qualify for special enrollment.

Special enrollment state guidelines

Each state treats special enrollment differently. Here are general guidelines for Oregon, Alaska and Washington. If you have experienced one of these qualifying events in the last 60 days, you may be eligible:

In Oregon:
  • You have gained a dependent or become a dependent through marriage, domestic partnership, birth, adoption, foster adoption, or placement for adoption
  • You have moved to a new service area
  • You or your dependent lost healthcare coverage due to one of these reasons:
    • Termination of employment
    • Divorce or end of domestic partnership
    • Over-aged dependents
    • Expiration of COBRA
    • Loss of eligibility for Medicaid or CHIP
    • QHP decertification
    • QHP enrollment or disenrollment due to HHS error
    • QHP material violation
    • Other loss of eligibility
  • Your income level changed and affects your ability to qualify for a health coverage tax credit or changes the amount of that tax credit
  • If you are a member of a federally recognized Indian tribe, you may enroll or change plans once a month throughout the year. Visit HealthCare.gov for a definition and full list of federally recognized tribes. To learn more about benefits available to American Indians, visit CMS.gov.

 

Health terms glossary

Healthcare lingo explained

Words about health coverage can be confusing. To make it easier for you, we put together this cheat sheet. After all, how can you expect to find your way to better health if the signs aren't clear? But watch out – the more you learn, the closer you get to being a health smarty pants, like us.

Accident benefit
Your coverage for care when you have an accident. You may get better benefits than for regular care. For example, your deductible might be waived for treatment related to that accident.
Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act (ACA). This federal law was signed by President Obama in 2010. Starting in 2014, the law requires you to have health insurance (with some exceptions) and gives you certain protections. For example, you cannot be rejected for having a pre-existing condition and your preventive care will be free. To learn more, visit healthcare.gov.
Alternative care
Services you receive from licensed alternative care professionals. The definition of alternative care can vary by state. In Oregon, some examples include naturopathy, acupuncture and chiropractic care. In Washington, some examples include acupuncture and spinal manipulation.
Balance billing
Charges for out-of-network care beyond what your health plan allows. Out-of-network providers may bill you the difference between the maximum plan allowance and their billed charges. In-network providers can't do this.
Be Better tools
Extras to help you stay healthy. Be Better tools come with every medical plan and are available through myModa. Examples include eDoc, a way to access licensed health specialists; Registered Nurse Advice Line, free phone support for health situations; health coaching services; and online tools to check drugs costs, review claims and find care.
Brand drugs
Patented drugs produced and marketed by a specific manufacturer.
Bronze tier plans
Plans that give you less coverage, but a lower monthly premium. Bronze plans cover more than the catastrophic tier, but less than silver and gold tiers.
Calendar year costs
What you pay each calendar year, January through December.
Catastrophic plan
Covers you if you have a serious accident, illness or other medical emergency. Catastrophic coverage is an affordable way to protect yourself from large, unplanned medical expenses. It usually has a high deductible and covers a very basic level of service.
Coinsurance
The percentage of medical costs you are responsible for paying. For example, you may pay 20 percent of a $200 bill, or $40. Moda Health pays the rest! Usually when you pay coinsurance, you will not have a copay.
Community Care Network (CCN)
This network serves Portland and Salem communities. It includes a select group of Legacy Health, Salem Health, Adventist Health and OHSU providers that work together to give you the best care. Enjoy access in Multnomah, Washington, Clackamas, Yamhill, Marion and Polk counties.
Copayment (copay)
A specific dollar amount you pay for a service. For example, you might pay $25 for each visit to a doctor's office. Moda Health pays the rest! Usually, you will not pay coinsurance if you have a copay.
Covered services
Services for which your plan pays a portion. Check your policy to make sure your care is a covered service. If you seek care that is not covered, you will have to pay for the entire cost yourself.
Deductible
The amount you pay before your plan starts to cover services. However, deductibles don't apply to preventive care, which is free, or to some services that have a copay instead.
Dependent
A family member who is on your health plan. Dependents can be your spouse or registered domestic partner and children.
Delta Dental
One of the largest networks of dentists in the country.
Dental plan
A plan that helps you pay for dental care.
eBill
Electronic billing services that allow you to pay your monthly premium online via your myModa account.
eDoc
Part of our Be Better tools, eDoc lets you get free online advice from board certified healthcare providers. Moda Health members can log in and ask physicians, pharmacists, psychologists, dentists, dietitians and fitness experts about any health concern.
Embedded pediatric dental
Dental coverage for children that comes as part of your family’s overall medical plan.
Exclusive Provider Organization (EPO)
A type of provider network. These are doctors, hospitals and other medical offices that accept your insurance. Participating providers agree to your insurance carrier's payments for specific services. Usually, in EPOs, costs are not covered if you visit a provider outside the network.
Explanation of benefits (EOB)
The statement that shows how your care was paid for. Your EOB lists the services you received, the dollar amount your provider charged, the amount covered by insurance and your share.
First Choice Health Network
If you live in Washington this is your medical network. It includes doctors, hospitals and other medical providers.
Generic drugs
Drugs with similar ingredients as brand-name counterparts, but sold for less
Gold tier plans
Plans that give you the highest level of coverage from Moda Health. They also have the highest monthly premiums.
Health Care Reform
Changes caused by the Affordable Care Act (ACA). The ACA is a federal law signed by President Obama. It requires certain changes to make insurance more affordable and higher in quality. Its goal is to give more people access to healthcare.
Health insurance marketplace
Also called an "exchange," a health insurance marketplace is an online hub where you can buy affordable health coverage. States either run their own health insurance marketplace or refer residents to the federal marketplace. If you qualify for a federal tax credit based on your income, you must buy your health plan through a marketplace in order to receive your credit.
Health plan / medical plan
Your health insurance policy. The health plan you choose will have its own set of benefits and monthly premium. Moda Health and other insurance carriers offer a variety of health plans.
Health savings account (HSA)
A way to save for qualified medical costs with tax-free dollars. With an HSA, you can pay for deductibles, coinsurance and other out-of-pocket expenses not covered by health plans, such as Lasik eye surgery or orthodontia. To be eligible, you must have a qualifying high-deductible health plan and open a HSA with a qualified trustee, such as a bank.
Inpatient care
Care you receive while you are checked in to a hospital or treatment center. Usually, you are admitted to a hospital only if you are seriously hurt or sick.
Marketplace navigators
These certified agents help folks navigate the health insurance marketplace, enroll in a health plan and apply for financial assistance. Their services are free. Oregon individuals who qualify for financial assistance and wish to receive it must use a navigator to enroll on the marketplace. CoverOregon.com is working on an online solution that will eventually allow individuals to do this for themselves.
myModa
Your personalized member website. Log in at modahealth.com/myModa to see your claims, benefits and Member Handbook. You can also use Be Better tools to help manage your health. Members can access myModa from a desktop computer or mobile device.
Network
A group of doctors, hospitals and other providers. If providers are in your network, they've agreed to accept your insurance at lower rates. Using an in-network provider keeps your out-of-pocket costs low.
ODS Plus Network
This is one of the largest PPO networks in the state of Oregon. It includes thousands of primary care physicians working with Moda Health to help keep you healthy.
ODS + Providence Alaska Network
This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Providence Alaska Medical Center as the preferred provider of acute care services in the Anchorage area.
ODS Alaska Select Network
This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area.
Out-of-pocket maximum
The total amount you could pay for care each year. After reaching your out-of-pocket maximum, Moda Health will pay 100 percent for the rest of your eligible healthcare expenses.
Out-of-pocket payments
Anything you pay to providers. This is your share of medical costs after Moda Health pays a portion.
Outpatient care
Care you receive from a doctor's office or other provider, without being checked into a hospital or treatment center. These are usually routine office visits.
Plan tiers
Plan categories of gold, silver, bronze and catastrophic. Our gold plans cost a little more, but they cover more, too. Silver plans fall somewhere in the middle. Bronze plans provide a little less coverage, but you’ll save money on monthly premiums.

We also have a catastrophic tier, which includes one plan. If you’re under 30 and meet some eligibility requirements, this plan offers coverage just in case of an emergency.

Each plan tier meets the requirements of the ACA. Knowing about these tiers may help you find and choose the best plan for you.
Pre-existing condition
A health problem or illness you had before applying for health insurance. Because of the Affordable Care Act, health plans can’t turn you down or charge you more for a pre-existing condition starting in 2014.
Preferred brand drugs
Medications for which you'll get better coverage under your Moda Health plan. If you have prescription coverage, these are certain brands of drugs that will cost you less out of pocket.
Preferred provider organization (PPO)
A type of provider network. These are doctors, hospitals and other medical offices that accept your insurance. Participating providers agree to your insurance carrier's payments for specific services. Usually, this means you pay lower out-of-pocket costs than if you visit a provider outside the network.
Premium
The monthly amount you pay for your health plan.
Preventive care
Medical services that help keep you healthy before you ever get sick. Examples of preventive care are vaccines, regular check-ups with your doctor and screenings. Preventive care is free with your health plan.
Primary care physician (PCP)
The type of doctor who treats you when you have a routine illness or injury. This doctor focuses on preventive care.
Provider
Any group or professional that provides you with care. Examples are hospitals, doctors and rehabilitation centers.
Registered Nurse Advice Line
Free phone support for basic health situations. The toll-free line is available to members, 24 hours a day, 7 days a week. Friendly nurses offer advice about symptoms, treating minor injuries, choosing cold and flu remedies, and knowing when to come in for care.
Rose City Network
This network includes Providence Health System physicians, clinics and facilities in the Portland metro area. You can access these providers in Multnomah, Washington, Clackamas and Yamhill counties.
Silver tier plans
Plans that give you a great combination of coverage and value, with mid-range monthly premiums. Silver plans give you better coverage than catastrophic and bronze plans, but less than gold plans.
Specialty care
Medical services that usually go beyond your primary doctor. Examples are oncology (cancer treatment), neurology (brain and nervous system) and many others. Specialty care almost always has different benefits than non-specialty care, so check your policy or call Moda Health Customer Service with questions.
Tax credit
Federal tax credits to help people pay for health insurance. You might qualify based on your income. To use a tax credit, you must buy insurance through your state's health insurance marketplace website.
Urgent care
Walk-in medical care you receive at a clinic that is not an emergency. You may visit an urgent care facility if you need medical help right away but your situation isn't serious enough for the emergency room.
Value drugs
Select, commonly prescribed products used to treat chronic medical conditions and preserve health.

Other resources for you

Find even more definitions about health coverage, medical claims and the Affordable Care Act on healthcare.gov/glossary. If you want a printable version, check out this handy Glossary of Health Coverage and Medical Terms PDF.

 

FAQs

Health coverage FAQs

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Why do I need health benefits?

It’s the law, but it also helps you and your family get medical care and stay healthy. Most people must carry health coverage starting in 2014. This is required by the Affordable Care Act. But health coverage is also a smart idea.

Almost everyone needs medical care at some point. A health plan helps pay for these costs. It also protects you from large, unexpected medical bills. Did you know that without health insurance, fixing a broken leg can cost up to $7,500?* It’s easy to see how health benefits might keep you out of debt or bankruptcy.

*According to healthcare.gov.

How does healthcare coverage work?

When you buy a plan, your health coverage company, like Moda Health, pays part of your medical costs if you get sick or hurt. You are responsible for paying some costs as well, such as:

  • Premium — Your monthly cost for your plan.
  • Deductible — The amount you pay before the plan starts to cover services beyond preventive care.
  • Copayment (copay) — A set dollar amount you pay for a service, like a doctor’s appointment.
  • Coinsurance — The percentage of a medical bill you pay, usually after you meet your deductible. You’ll pay either coinsurance or a copay for a service, but not both at the same time.
What do health plans cover?

Health plans give you free preventive care. All Moda Health plans include that benefit. They also pay for part of your other healthcare costs. Once you reach deductible and out-of-pocket maximum, Moda Health pays the remainder of your medical expenses. And, there is no dollar limit on your essential health benefits, so you can keep receiving the care that you need.

What is preventive care?

It’s what keeps you healthy before you ever get sick. Examples of preventive care are vaccines, regular checkups with your doctor and screenings.

Open and special enrollment FAQs

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When is open enrollment for individual medical plans?

Each year, open enrollment starts in the fall and lasts several weeks.

For 2014 individual medical coverage, the open enrollment period ran October 1, 2013, through March 31, 2014. In Washington, people under age 19 can also enroll March 15 through April 30, 2014.

For 2015 coverage, the open enrollment period is November 15, 2014, through February 15, 2015.

Can I enroll in a plan only during open enrollment?

Yes, unless you qualify for special enrollment.

When I enroll, how can I apply for federal tax credits?

If you qualify for and want to use tax credits , you must enroll in a health plan through your state’s marketplace. You could receive this credit in monthly payments or as a lump sum after you file your taxes.

How do I qualify for special enrollment?

Certain life events might qualify you for special enrollment. For example, getting married, having a baby or moving to a new state could make you or those you cover eligible.

Was 2014 open enrollment extended for Oregon residents?

Sort of. The initial deadline was March 31, 2014. But, Oregonians can now enroll April 1 through April 30, 2014, as part of a special extended enrollment period. However, if you enroll in April, you could pay a partial federal penalty for not enrolling before the initial March 31, 2014, deadline. To learn more about penalties, visit Cover Oregon.

If I live in Alaska or Washington, can I still enroll in a 2014 medical plan?

In Alaska and Washington, open enrollment ended March 31, 2014. However, you still have options. You can wait to enroll until the next open enrollment period, November 15, 2014, through February 15, 2015. Or, you may able to qualify for special enrollment before then.

When can I sign up for dental coverage?

There is no enrollment period for dental coverage, so you can enroll in a dental plan anytime. If you live in Oregon or Alaska, just visit our retail website now to find a dental plan you like.

Moda Health plan FAQs

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Which Moda Health plans are available in my state?

Our plan availability varies by state:

  • In Oregon, you can choose from 14 plans: Be Protected, Be Focused, Be Focused – Rose City (marketplace only), Standard Gold plan, Be Prepared, Be Smart, Be Aligned, Be Aligned – Rose City (marketplace only), Standard Silver Plan, Be Connected, Be Connected – Rose City (marketplace only), Be Savvy, Standard Bronze Plan, Be Bold (marketplace only)
  • In Washington, we offer two plans:  Be Protected and Be Prepared.
  • In Alaska, six plans are available: Be Protected, Be Prepared, Be Aligned, Be Connected, Be Savvy and Be Bold (marketplace only).
How do I pick the right Moda Health plan?

You have a lot of choices, both in plans and carriers. You can find Moda Health plans here, and we’re confident there’s one to fit your needs. Visit Pick the right plan to learn more.

Here are some things to consider as you shop:

  • How much can you afford in monthly premiums? You can choose a plan with a lower monthly cost, but you will pay more out-of-pocket for care.
  • What kind of medical care do you use throughout the year? If you visit your doctor often, have a serious health condition or see specialists, you may want a lower deductible and better coverage. If you’re healthy and see your doctor only occasionally, you might consider a higher deductible. 
  • How much of your care is preventive? Preventive care is free and not subject to a deductible.
  • How much of your care goes beyond preventive services? You will likely owe a copay or coinsurance for these services.
  • Do you use a lot of prescription drugs? If so, it may be worth purchasing a plan with strong prescription drug coverage.
  • Will you add dependents? If so, consider their health issues and what kind of care they’ll need.
  • How would you handle an unexpected medical bill? If you have a medical emergency, like a broken arm or serious illness, you could face thousands of dollars in medical bills. How much will you be able to pay before needing coverage for the rest?
  • How do you feel about the health coverage company? It’s important to consider customer service, wellness programs, 24/7 nurse advice lines, education and online tools. We offer these things and more, at no extra cost. At Moda Health, we do everything we can to be your partner on your journey to better health.
  • Do you use providers in the plan’s network? To check Moda Health’s network, click on “Find care” at modahealth.com.
Should I choose a health plan with a high or low deductible?

A high deductible will save you money on your monthly premiums. However, you’ll have to spend more out-of-pocket before your plan pays for benefits. With a low deductible, your plan will cover benefits earlier, but you’ll pay a higher premium every month.

You should carefully consider your healthcare needs. If you and your covered dependents see a doctor mostly for preventive care and occasionally for minor issues, it might be a good idea to choose a high-deductible plan. After all, preventive care is free, and many office visits can be covered with a copay.

On the other hand, if you have a serious health condition, see specialists or tend to visit your doctor often, you might be better off with a low-deductible plan. You may also want a low-deductible plan if you don’t want to risk the higher costs that come with a medical emergency.

Can I add family members to my health plan?

Yes! These are known as dependents. You can add your qualified spouse. In Oregon and Washington, you may insure a married spouse or registered domestic partner. In Alaska, you may insure a married spouse. You can also add your dependent children. Keep in mind that you will pay a higher premium for adding dependents.

Is my doctor in a health plan network?

It depends. Moda Health has a wide network of providers, but you should always check to make sure your doctor is part of it. You can use our “Find Care” tool atmodahealth.com.

What’s the difference between a copay and coinsurance?

A copay is a specific dollar amount you pay for a service. For example, you might pay $25 for a visit to your doctor’s office. Often, you don’t have to meet your deductible for services that are covered with copays (but check your plan details to make sure).

Coinsurance is the percentage of costs you must pay. Most often, you must meet your deductible before coinsurance applies. For example, you may pay 20 percent of the cost of a $200 bill, or $40. Moda Health pays the rest! Usually, you will either pay a copay or coinsurance, but not both at the same time.

Which plans does Moda Health offer?

We offer a variety of individual medical and dental plans. We invite you to explore plans to see which of our plans are available in your state. Our plans vary by price, network, deductible and copays for covered services.

Which Moda Health plans are available in my state?

Our plan availability varies by state:

  • In Oregon, you can choose from 14 plans: Be Protected, Be Focused, Be Focused – Rose City (marketplace only), Standard Gold plan, Be Prepared, Be Smart, Be Aligned, Be Aligned – Rose City (marketplace only), Standard Silver Plan, Be Connected, Be Connected – Rose City (marketplace only), Be Savvy, Standard Bronze Plan, Be Bold (marketplace only)
  • In Washington, we offer two plans: Be Protected and Be Prepared.
  • In Alaska, six plans are available: Be Protected, Be Prepared, Be Aligned, Be Connected, Be Savvy and Be Bold (marketplace only).
Are all Moda Health plans available on the health insurance marketplace?

Some Moda Health plans can be purchased directly from Moda Health. Others must be purchased on a marketplace. It all depends on your state.

  • In Oregon, you can purchase all Moda Health plans, except these, through our website: Be Bold, Be Connected – Rose City, Be Aligned – Rose City and Be Focused – Rose City. To buy these plans, visit the Oregon marketplace atcoveroregon.com.
  • In Washington, you can purchase Be Protected and Be Prepared only from us.
  • In Alaska, you can purchase all six plans through Moda Health or the federal health insurance marketplace at healthcare.gov. But, you only buy the Be Bold plan on the federal marketplace.
What determines the monthly premium I pay for my plan?

Thanks to Health Care Reform, only two things affect your monthly premium. The first is the plan you choose. Some plans cost more because they offer greater benefits. The second is age. Your age and the ages of everyone covered by your plan add up to create your total family rate.

Your rate will go up a little each year until you turn 65. If you are covering children under age 21, they each have the same rate based on the plan. However, you only need to include up to three children under age 21 in your total. Child dependents age 21 through 25 have a rate based on their actual age.

Explore plans now to find a plan and see what you would pay.

Health Care Reform FAQs

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Cover Oregon recently announced information about retroactive tax credits, am I eligible?

You might be. Cover Oregon announced Tuesday, June 10 that members living in Oregon may be eligible for retroactive tax credits if they meet certain criteria. You qualify if:

  • You enrolled in a qualified health plan outside of Cover Oregon, meaning, you enrolled directly with the carrier for a 2014 plan.
  • You attempted to enroll through Cover Oregon before April 1, 2014 but had technical issues when trying to enroll.

Next steps

If you meet the criteria listed above, you must contact Cover Oregon by June 27, 2014 to report your case. Cover Oregon can be reached at 855-268-3767.

What is the Patient Protection and Affordable Care Act (ACA)?

The ACA is a federal law signed by President Obama. It’s also called Health Care Reform. The law requires certain changes to make insurance more affordable and higher in quality. Its goal is to give more people access to healthcare.

Does the ACA mean I have to buy health insurance?

Most people will need to have health insurance starting in 2014. There are a few exceptions, such as having a very low income. If you don’t carry health insurance, you may owe a fine. You can find the details at healthcare.gov.

Your employer may already offer you a health plan. If you do not have coverage through your employer, you will probably need to buy insurance on your own. This is called an individual or family plan.

Can health insurance companies turn me down for a pre-existing condition?

Not anymore. You may have been denied health insurance in the past if you had a pre-existing health condition, which means you were sick or had a health issue. The Affordable Care Act puts an end to that, starting in 2014.

What is a health insurance marketplace?

Also called an “exchange,” a health insurance marketplace is an online hub where you can buy affordable health coverage. States either run their own health insurance marketplace or refer residents to the federal marketplace. Starting October 2013, you can buy affordable coverage on these websites if you qualify for a federal tax credit. If you don’t qualify for a tax credit, you can buy a health plan directly from Moda Health. We have a variety of individual and family plans to fit everybody!

Do I have to buy my insurance on the marketplace?

You don't have to buy health insurance on a marketplace website unless you qualify for a tax credit. If you do qualify for a tax credit, and want to use it, you must enroll through the marketplace website. This helps the state make sure you get your refund.

What are health coverage tax credits?

These federal tax credits help people pay for health insurance. To receive this credit, you must qualify based on income. You must also enroll in a health plan through your state’s marketplace. You could receive this credit in monthly payments or as a lump sum after you file your taxes.

Am I eligible for a tax credit?

Use the calculator on your state’s marketplace website to see whether you qualify. You may need to provide your income, age and household size.

If I apply for a special enrollment, can I still qualify for tax credits?

Yes, you can still earn tax credits if you choose a special enrollment. Just visit your state’s health plan marketplace to learn more about tax credits and how to qualify for coverage outside of open enrollment. If you qualify and want to use your tax credit, you need to enroll in a health plan on the marketplace.

Can I buy my health plan from Moda Health and still get a tax credit?

No, in order to get a tax credit you must enroll for a health plan on an official health insurance marketplace website. Once there, you’ll apply for the tax credit and then choose your plan.

If you don’t qualify for a tax credit, you can apply for your Moda Health plan right here. Visit Explore plans to get started.

Health savings account FAQs

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What is a health savings account (HSA)?

An HSA helps you save for medical costs with tax-free dollars. With an HSA, you can pay for deductibles, coinsurance and other qualified expenses. To be eligible, you must have a qualifying high-deductible health plan and open a HSA with a qualified trustee, such as a bank.

Which Moda Health plans include an HSA?

You can pair our Be Savvy plan with an HSA.