Moda Health and Delta Dental plan FAQs
What plans do Moda Health and Delta Dental offer?
We offer medical plans in Alaska, Idaho, Oregon and Texas, and dental plans in Alaska and Oregon. Our plans vary by price, network, deductible and copays for covered services. Shop our plans to see what’s available.
How do I pick the right Moda Health plan?
You can find Moda Health plans here, and we’re confident there’s one to fit your needs.
Here are some things to consider as you shop:
- Where do you get care? You can choose a plan that includes your doctors, practitioners, hospitals, labs and other provider type in the network. Remember, the Oregon medical plans and dental EPO plan and Texas medical plans do not include out-of-network coverage except for emergency and retail pharmacy. So if your provider is not in the network, you are responsible for the full cost of the services. Our Alaska plans do not cover out-of-state coverage except for emergency services, coverage through medical travel support program, coverage through out-of-state contracted providers and medically necessary nonemergency services that are prior authorized by us.
- What if my child does not live with me? Our medical plans do not cover services outside the United States except for emergency care. For medical plans in Oregon, if you have children you want to cover as dependents who live in the U.S. outside of Oregon, they may be eligible for out-of-area benefits if they are full-time students age 18 to 26, or if you have a qualified medical child support order (QMCSO). When seeking care in Oregon, all of your family members must use providers in your network to be covered. For medical plans in Idaho and Texas, we cover children who live in the US but outside of the network service area if you have a qualified medical child support order (QMCSO).
- How much will you budget for 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.
- Do you use a lot of prescription medications? If so, it may be worth purchasing a plan with strong prescription medication coverage.
- Will you include 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 budget to pay out-of-pocket before needing coverage for the rest?
- What other benefits and resources matter to you? It's important to consider customer service, gym discount programs, specialty provider service discounts, identity protection, education and online tools. We offer these things and more, at no extra cost. At Moda Health, we do everything we can to partner with you on your journey to better health.
Which plans can I purchase through a government exchange?
Alaska, Idaho, and Oregon residents can enroll in Moda Health Individual medical plans directly with us, via HealthCare.gov, or on the Idaho state exchange at YourHealthIdaho.org. Texas residents can shop our plans here, but must enroll on Healthcare.gov. Some plans may be available only through HealthCare.gov or directly with us.
Is my doctor in my health plan network?
It depends. Moda Health networks include a wide selection of providers. When you shop for a plan, you’ll search for providers that are in the network that comes with your plan.
Why do I need to choose an in-network primary care provider (PCP)?
In Oregon and Texas, our exclusive provider organization (EPO) plans connect you with your primary care provider (PCP), who works closely with Moda Health and the rest of your care team (other providers, specialists, etc.) to help you achieve better health and wellness. Moda Health will work with your selected PCP to make sure you can quickly access the care that is right for you.In Alaska, you can see any licensed provider in the state to get care. In Idaho, our managed care plans connect you with your primary care provider (PCP). When you use a PCP and other in-network providers, you get a higher benefit.
How do I find an in-network PCP?
To find a PCP, start by shopping for a plan. On the medical plans page, you’ll find an option to search for a PCP.
Do plans cover acupuncture and spinal manipulation?
Yes, all Oregon Moda Health medical plans cover medically necessary acupuncture and spinal manipulation. All Alaska Moda Health medical plans cover medically necessary acupuncture, spinal manipulation and massage therapy. All Texas Moda Health medical plans include spinal manipulation as part of the outpatient rehabilitation coverage. All Idaho Moda Health medical plans cover spinal manipulation.
Is massage therapy covered?
Our Alaska plans do cover massage therapy. Our Oregon, Texas and Idaho plans do not cover massage therapy.
Can I see a naturopath physician under my plan?
Yes. For Idaho, Oregon and Texas plans, office visits with a naturopathic physician are covered at the specialist office visit amount. However, if your naturopathic physician is a credentialed PCP, your visit may be paid at the PCP office visit level.
For Alaska plans, naturopathic physicians are covered at the PCP office visit amount.
What payment methods do you accept?
We accept checks, money orders and electronic funds transfers (EFT) from a savings or checking account. Just select the billing and payment option that is best for you:
- eBill, our electronic billing service. You can review your premium invoice and make payments online through the Member Dashboard, your personalized member website. Visit modahealth.com and follow the instructions to create a your Member Dashboard account.
- Electronic funds transfer (EFT). To use EFT, contact us and complete an EFT authorization. Your premium invoice will be paperless and located in the eBill section of your Member Dashboard.
- Paper bill. We’ll send you a paper bill in the mail every month. You can mail back your payment in the enclosed envelope or initiate a payment through eBill after logging in to your Member Dashboard.
How will I make my first premium payment?
You’ll receive your first premium invoice prior to your effective date, either by mail or by email. If you enrolled directly through us, use the payment method you chose during enrollment to pay your premium. If you enrolled through HealthCare.gov or YourhealthIdaho.org, make your payment using one of the methods listed in your welcome letter.
How can I use my benefits while traveling outside my health plan’s network service area?
For our Oregon medical plans, while traveling outside of Oregon, members can receive emergency care through the Aetna® PPO Network.
For our Alaska medical plans, while travelling outside of Alaska, members can receive emergency or urgent care through the Aetna® PPO Network and get Tier 1 benefits.
For our Texas plans, while traveling outside of the service area, members can receive in-network emergency or urgent care through the First Health Network.
For our Idaho plans, while traveling outside of the service area, members can receive in-network emergency or urgent care through the First Health Network.
I am traveling outside of the United States. Am I covered under my Moda Health plan?
Outside the United States, members may access any provider for emergency care or urgent care. You are required to pay your bill before submitting your claim to Moda Health. All other non-emergency and non-urgent care received outside the U.S. is not covered.