Moda Select Idaho Silver 4000 + Vision Exam - 73% CSR

Moda Health Plan, Inc. · 2026 plan year

Silver

Ind. deductible: $4,000
Family deductible: $4,000
Ind. OOP max: $7,500
Family OOP max: $7,500

Other cost-sharing reduction variants for this plan:

87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Standard Silver On Exchange Plan Zero Cost Sharing Plan Variation

More Moda Health Plan, Inc. plans in ID

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

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$5.00

Specialist

Benefit	In-network
Specialist Visit	$50.00

Hospital

Benefit	In-network
Emergency Room Services	$350.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	40.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$50.00

Pharmacy

Benefit	In-network
Generic Drugs	$20.00
Non-Preferred Brand Drugs	50.00% Coinsurance after deductible
Preferred Brand Drugs	40.00%
Specialty Drugs	40.00%

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$5.00

Other

Benefit	In-network
Allergy Testing	40.00% Coinsurance after deductible
Chemotherapy	40.00% Coinsurance after deductible
Chiropractic Care	$50.00
Delivery and All Inpatient Services for Maternity Care	40.00% Coinsurance after deductible
Diabetes Education	40.00% Coinsurance after deductible
Dialysis	40.00% Coinsurance after deductible
Durable Medical Equipment	40.00% Coinsurance after deductible
Emergency Transportation/Ambulance	40.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Gender Affirming Care	40.00% Coinsurance after deductible
Habilitation Services	$50.00
Hearing Aids	40.00% Coinsurance after deductible
Home Health Care Services	40.00% Coinsurance after deductible
Hospice Services	40.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	40.00% Coinsurance after deductible
Infusion Therapy	40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	$60.00
Nutritional Counseling	40.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$5.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	40.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$50.00
Prenatal and Postnatal Care	40.00% Coinsurance after deductible
Prosthetic Devices	40.00% Coinsurance after deductible
Radiation	40.00% Coinsurance after deductible
Reconstructive Surgery	40.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$50.00
Rehabilitative Speech Therapy	$50.00
Routine Eye Exam (Adult)	$10.00
Routine Eye Exam for Children	No charge
Routine Foot Care	40.00% Coinsurance after deductible
Skilled Nursing Facility	40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	40.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$5.00
Transplant	40.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	$60.00
Accidental Dental	40.00% Coinsurance after deductible

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