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Moda Health Review

Moda Health only offers insurance in Oregon and Alaska, but Moda Health Insurance plans includes individual and family PPO plans as well as dental. Our Moda Health Review finds this insurance company to be competitive in its local market.

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Jul 16, 2020

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Moda Health is a large insurance company based out of Portland, Oregon, and provides health insurance to individuals and families as well as through employers. Currently, they offer new plans only in Oregon and Alaska.

About Moda

Moda Health was founded in 1955 as a dental insurance plan under the name Oregon Dental Society (ODS). While the company continues to offer dental insurance, they also moved into the health insurance market, and in 2013 took on the name Moda Health. Moda expanded brand awareness with a sponsorship deal for the Portland Trailblazers that renamed their stadium to the Moda Center, a landmark in the city of Portland.

Moda offered health insurance plans through employers and directly to individuals in three states – Oregon, Washington, and Alaska – until 2016 when the company stopped selling insurance in Washington. During this same time period, Moda faced sanctions from the other two states in which it sells insurance due to financial difficulties. Moda successfully sued the federal government for promised financial assistance that led to the company’s difficulties and is once again writing new policies in Alaska and Oregon.

Moda’s current plans include individual and family PPO coverage, Medicare, and a dental insurance through a partnership with Delta Dental. Products are sold directly through the company website and over the phone, as well as through the insurance marketplace.

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Moda Products

Moda’s health care plans are managed care with a primary care provider but do not require a referral to see a specialist. Their Beacon network offers providers within a range of different well-known local medical groups, and out-of-network coverage is available, usually after the deductible is met. Plans are offered at bronze, silver, and gold levels. Dental plans can be purchased separately through partner Delta Dental.

We researched the plans based on the zip code of Moda’s Portland, Oregon headquarters.

Standard Plans

Oregon Standard Bronze is the only option at the bronze level and features higher deductibles and copays in return for lower monthly rates. The individual deductible under this plan is $7,150 and the family deductible $14,300; these are also the out of pocket limits for the plan. A primary care visit carries a $70 copay, while a specialist visit carries a $115 copay.

The Oregon Standard Silver has deductibles of $2,500 per person and $5,000 family. Copays are $35 for a primary care visit and $70 for a specialist visit.

The Oregon Standard Gold plan has the lowest out of pocket costs of the standard plans, but higher monthly premiums. Deductibles are $1,000 individual and $2,000 family, with copays of $20 for a primary care visit and $40 for a specialist visit.

Other Plans

The Moda “Be” plans are offered with four different choices, although there is no bronze plan available.

The Be Steady plan is a silver-level product with deductibles at $3,650 individual and $7,300 family. Rather than copays, this plan has 25% coinsurance for all office visits.

The Be Prepared plan is also a silver-level plan. This plan has lower deductibles at $2,250 individual and $4,500 family. Copays are $30 for both primary care and specialist visits.

The Be Protected plan is a gold-level plan with deductibles that match the Standard Gold plan at $1,000/$2,000, but lower copays. Primary care visits are $15, and specialist visits are the same

The final choice is the Be Integrated plan, which is also a gold plan. This plan has Moda’s lowest deductibles at $500 per person and $1,000 per family, but the copays are higher than with the Be Protected plan, instead matching the Standard Gold at $40 for primary care and $40 specialist.

Dental Plans

There are four available Delta Dental plan options, all of which are PPO plans. All but one are zero-deductible plans; the Delta Dental Premier plan has a $50 deductible.

The Delta Dental PPO Bright Smiles is the only plan without an annual maximum for coverage. Plan coverage ranges from 100% coverage to 50% coinsurance depending on the option chosen.

Moda Rates

We obtained rates based on a single 30-year-old insured with no dependents. Moda’s least expensive plan, the Bronze Standard, came back at $312 per month for this sample. The Gold Be Integrated plan was the most expensive at $390 per month.

The difference in cost between the plans is not as great as we would expect given the disparity in deductibles and copay amounts, as well as out of pocket maximums. Overall, we found the lower end plans to be fairly expensive and the higher end plans a better value, based on the limited information offered.

As Moda only covers a small region, we are unable to compare them to our usual sample rates or on a national level.

Claims

Moda handles all claims internally, as do all health insurance companies, although there may be more involved with dental claims on the PPO network than with those going through the medical Beacon network.

Out-of-network claims may take longer to process than in-network, but should also be handled directly by the provider.

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Ratings and Consumer Reviews

Moda currently has an A+ rating with the Better Business Bureau (BBB). There have been 35 complaints filed in the past three years, eight of which were closed in the last 12 months. These numbers are low for a company the size of Moda.

Moda does not appear on any of the major review sites, but there are reviews on Yelp under the old name, ODS. While there are many negative reviews, there are also quite a few positive reviews, which is always encouraging. The lack of other reviews is likely due to both the name change and the fact that Moda has not been in the health insurance market for very long.

Moda’s financial woes are most apparent in a reviews and rating search of the company, however, their victory in court over government funding is likely to tilt things back in their favor.

The Bottom Line

Moda is one of the larger insurers in Oregon and is in the process of recovering from financial difficulties. Their plans are on the expensive side, but the higher coverage plans do not carry much larger premiums than lower end ones, making them a potentially good value. Moda may need some more time to settle into the market and get past the stain of financial problems before they can be completely recommended, but they do appear to be on the right track.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

9 Comments

  1. Just tried to schedule an outpatient surgery for a MODA-BEACON plan patient.

    I was just told that in all of Portland, I could only take her to Portland Clinic’s surgery center, which I can’t because I’m not a Portland Clinic doc, or a hospital in Salem!!!!!!!

    Time for me to drop MODA!

    Reply
  2. NEVER, NEVER enroll with Moda!

    They sent me a threatening letter last week for allegedly not paying for my May premium

    Several days after that, they cut off my insurance like they don’t give a d@#% about my health like they advertise they would.

    Meanwhile, they were cashing the checks I paid from January to July.

    I’m paying online through Maps Credit Union.

    Maps CU called Moda and told them that the checks they sent for me have been posted in their account!

    Found out later that one of my payments was credited to somebody else’s account!

    When I called them and raised hell about it, all they could say is “sorry it happens sometimes.”

    These dirtbags don’t care about your health, all they care about is your money.

    If I had an emergency between those dates that they cut me off my insurance due to their fault, I would have been f***ed up!

    And a big lawsuit could follow.

    I would have been forgiving if they had the decency to send me a letter asking me to call them for some discrepancy instead of a threatening one and finally cutting me off.

    They don’t even know their employees (or maybe they hire somebody overseas to take care of their screw ups).

    A lady (I don’t divulge names) left a message assuring me that it won’t happen again and that my account has been reactivated.

    So I called them to the number that she left, nobody in that office can identify the lady’s name, both their dental and medical section.

    Think about that! That’s how screwed up this company is!

    Reply
  3. Will not have moda health ever again they don’t communicate like they say they do.

    And now I find out from my dr. that they canceled my plan for not pay witch is wrong played ever month have a check to prove it and was told sorry but you can sign up again when open enrollment

    Come up I think not will never do business with these people can not trust them sorry company

    Reply
  4. MODA is a joke, A bad joke.

    They play games with coverage and you have to fight to get a claim paid at any amount.

    We have been stuck with their dental and it’s a fight to the death to get them to pay anything.

    Trust me if you have a choice don’t choose MODA. You’ll be sorry.

    Reply
  5. Do not get Moda health. I have been regretting signing up with them every moment I have them.

    They have very few selections for any kind of care and make if very hard to find a provider.

    They have no primary care physicians that are available.

    I reported all the primary care providers that weren’t actually working at the clinics or medical facilities on the website and they are still there 3 months later.

    I still don’t have a PCP because I haven’t found a single person that is still in practice on their list.

    I haven’t been to the gynecologist since I signed with their plan.

    My medication cost has doubled since I’ve been with them.

    Please get a reputable plan and avoid MODA. If I could change mid-year I would. Avoid.

    Reply
  6. Moda reminds me of One Integrated Wellness. They try to force potassium on you when you don’t need it.

    Reply
  7. Moda is despicable. They never want to reimburse anything and hassle you until (they hope you will give up).

    After I broke my arm overseas they had the nerves to write me that Moda only reimburses emergencies overseas.

    What is a broken elbow and a dislocated wrist considered while one cannot get off the bed from pain and was scooped up from the ground by daughter and friend?

    Reply
  8. Moda is irresponsible and does not authorize claims. They hire another firm to authorize claims who are on the east coast and the Eastern time zone. When our neurosurgeon questioned them last week about a needed and necessary MRI they said their computers were down and we had to wait for another week and travel an additional 350miles. I have found Moda to be irresponsible and non-responsive to peoples needs.

    Reply
  9. I am currently insured with Health-Net 1 Violet Plan with a monthly premium of 105.00 . I am a male 87 years old and receive V.A. health benefits and am also covered under Medicare. I am considering a Plan with Moda that has a low cost premium of just 16.00 a month. Any comments and suggestions?

    Reply

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