Moda Pathways Oregon Silver 5000 - 94% CSR

Moda Health Plan, Inc. · 2027 plan year

Silver

Ind. deductible: $300
Family deductible: $600
Ind. OOP max: $1,800
Family OOP max: $3,600

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% 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 OR

Moda Select Oregon Silver 5000 Moda Select Oregon Bronze 9000 Moda Pathways Oregon Bronze 9000 Moda Select Oregon Standard Gold

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	$10.00

Specialist

Benefit	In-network
Specialist Visit	$20.00

Hospital

Benefit	In-network
Emergency Room Services	20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	20.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	20.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$20.00

Pharmacy

Benefit	In-network
Generic Drugs	$5.00
Non-Preferred Brand Drugs	50.00% Coinsurance after deductible
Preferred Brand Drugs	40.00%
Specialty Drugs	45.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	20.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$10.00

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	No charge
Accidental Dental	20.00% Coinsurance after deductible
Acupuncture	$10.00
Allergy Testing	20.00% Coinsurance after deductible
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	$10.00
Cosmetic Surgery	20.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care	20.00% Coinsurance after deductible
Diabetes Education	20.00% Coinsurance after deductible
Dialysis	20.00% Coinsurance after deductible
Durable Medical Equipment	20.00% Coinsurance after deductible
Emergency Transportation/Ambulance	20.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	$20.00
Hearing Aids	20.00%
Home Health Care Services	20.00% Coinsurance after deductible
Hospice Services	20.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	20.00% Coinsurance after deductible
Infusion Therapy	20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	20.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	20.00% Coinsurance after deductible
Nutritional Counseling	20.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$10.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	20.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$20.00
Prenatal and Postnatal Care	20.00% Coinsurance after deductible
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	20.00% Coinsurance after deductible
Reconstructive Surgery	20.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$20.00
Rehabilitative Speech Therapy	$20.00
Routine Eye Exam (Adult)	$10.00
Routine Eye Exam for Children	No charge
Routine Foot Care	20.00% Coinsurance after deductible
Skilled Nursing Facility	20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	20.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$10.00
Telehealth - Primary Care	$10.00
Telehealth - Specialist	$10.00
Transplant	20.00% Coinsurance after deductible
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	20.00% Coinsurance after deductible

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