Moda Select Idaho Gold 2200 + Vision Exam
Moda Health Plan, Inc. · 2026 plan year
Gold
- Ind. deductible
- $2,200
- Family deductible
- $2,200
- Ind. OOP max
- $7,600
- Family OOP max
- $7,600
Compare with other Gold plans in ID
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Moda Health Plan, Inc. plans in ID
Monthly premiums by age
Rating Area 3 — the lowest-priced of the 6 areas this plan covers. Premiums differ by area.
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $305 | $305 |
| 21 | $399 | $458 |
| 30 | $453 | $520 |
| 40 | $510 | $586 |
| 50 | $712 | $819 |
| 60 | $1,082 | $1,244 |
| 64 and over | $1,196 | $1,375 |
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 | $30.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | 10.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | 10.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services | 10.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities | $30.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $5.00 |
| Non-Preferred Brand Drugs | 50.00% |
| Preferred Brand Drugs | 30.00% |
| Specialty Drugs | 30.00% |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | 10.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $10.00 |
Other
| Benefit | In-network |
|---|---|
| Accidental Dental | 10.00% Coinsurance after deductible |
| Allergy Testing | 10.00% Coinsurance after deductible |
| Chemotherapy | 10.00% Coinsurance after deductible |
| Chiropractic Care | $30.00 |
| Delivery and All Inpatient Services for Maternity Care | 10.00% Coinsurance after deductible |
| Diabetes Education | 10.00% Coinsurance after deductible |
| Dialysis | 10.00% Coinsurance after deductible |
| Durable Medical Equipment | 10.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance | 10.00% Coinsurance after deductible |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | 10.00% Coinsurance after deductible |
| Habilitation Services | $30.00 |
| Hearing Aids | 10.00% Coinsurance after deductible |
| Home Health Care Services | 10.00% Coinsurance after deductible |
| Hospice Services | 10.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs) | 10.00% Coinsurance after deductible |
| Infusion Therapy | 10.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services | 10.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services | 10.00% Coinsurance after deductible |
| Nutritional Counseling | 10.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $10.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 10.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services | $30.00 |
| Prenatal and Postnatal Care | 10.00% Coinsurance after deductible |
| Prosthetic Devices | 10.00% Coinsurance after deductible |
| Radiation | 10.00% Coinsurance after deductible |
| Reconstructive Surgery | 10.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $30.00 |
| Rehabilitative Speech Therapy | $30.00 |
| Routine Eye Exam (Adult) | $10.00 |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | 10.00% Coinsurance after deductible |
| Skilled Nursing Facility | 10.00% Coinsurance after deductible |
| Substance Abuse Disorder Inpatient Services | 10.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $10.00 |
| Transplant | 10.00% Coinsurance after deductible |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 10.00% Coinsurance after deductible |
Service area
This plan covers 33 geographic areas.
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