SimpliveraCoverage Companion

Moda Select Idaho Silver 4000 + Vision Exam - 87% CSR

Moda Health Plan, Inc. · 2026 plan year

Silver
Ind. deductible
$1,000
Family deductible
$1,000
Ind. OOP max
$2,300
Family OOP max
$2,300

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan94% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver Off Exchange PlanStandard Silver On Exchange PlanZero Cost Sharing Plan Variation

More Moda Health Plan, Inc. plans in ID

Moda Select Idaho Silver 6400 + Vision ExamModa Select Idaho Bronze 9200 + Vision ExamModa Select Idaho Gold 1100 + Vision ExamModa Select Idaho Gold 2200 + Vision Exam

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$5.00

Specialist

BenefitIn-network
Specialist Visit$40.00

Hospital

BenefitIn-network
Urgent Care Centers or Facilities$40.00
Emergency Room Services$300.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible

Pharmacy

BenefitIn-network
Specialty Drugs40.00%
Preferred Brand Drugs40.00%
Generic Drugs$20.00
Non-Preferred Brand Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$5.00

Other

BenefitIn-network
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$40.00
Rehabilitative Speech Therapy$40.00
Routine Eye Exam (Adult)$10.00
Routine Eye Exam for ChildrenNo charge
Routine Foot Care30.00% Coinsurance after deductible
Skilled Nursing Facility30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$5.00
Transplant30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$60.00
Prosthetic Devices30.00% Coinsurance after deductible
Prenatal and Postnatal Care30.00% Coinsurance after deductible
Accidental Dental30.00% Coinsurance after deductible
Allergy Testing30.00% Coinsurance after deductible
Chemotherapy30.00% Coinsurance after deductible
Chiropractic Care$40.00
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Diabetes Education30.00% Coinsurance after deductible
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Gender Affirming Care30.00% Coinsurance after deductible
Habilitation Services$40.00
Hearing Aids30.00% Coinsurance after deductible
Home Health Care Services30.00% Coinsurance after deductible
Hospice Services30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infusion Therapy30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services$60.00
Nutritional Counseling30.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$5.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services$40.00

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