Moda Health Insurance Review & Complaints (2024)

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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, Alaska and Texas (as of 2022). Customers can shop online to compare the average health insurance cost per month with Moda Health.

What is 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 coverage, 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 and medical plans 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. Finding the best Oregon car insurance isn’t the only thing you can do online, as it’s just as easy to find Oregon health insurance.

What products are offered by Moda?

Moda’s health care plans are managed care with a primary care provider but the health plan does 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. Health insurance plans are offered at bronze, silver, and gold levels. Dental plans can be purchased separately through partner Delta Dental.

We researched the health insurance 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 health insurance 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 health insurance plans. 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 for the insurance policies are $35 for a primary care visit within the network of doctors 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 health insurance premiums. The lower deductible health plan 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

Moda currently offers a range of health plans that vary with the state you reside in (Oregon, Alaska or Texas). The differences can be referenced from the Moda insurance website.

In recent years, Moda offered the Moda “Be” plan with a variety of choices.

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.

Are Moda rates competitive?

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.

How are claims processed?

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.

Moda Health Insurance: Streamlined Excellence in Claims Processing

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Moda Health offers multiple channels for filing insurance claims, providing convenience and flexibility to policyholders. You can file a claim with Moda Health through their online portal, over the phone, or by using their mobile app. This variety of options allows you to choose the method that best suits your preferences and needs.

Average Claim Processing Time

Moda Health strives to process claims efficiently to ensure that policyholders receive timely reimbursements for covered expenses. However, specific claim processing times may vary depending on the nature of the claim, the completeness of documentation provided, and other factors.

It is advisable to check with Moda Health for information on the average claim processing times for your specific policy.

Customer Feedback on Claim Resolutions and Payouts

Moda Health’s approach to handling claims is crucial in maintaining customer satisfaction. While the article does not provide specific customer feedback on claim resolutions and payouts, it is essential to consider real-world experiences and reviews from policyholders when evaluating an insurance company.

You may want to explore online reviews and customer testimonials to gain insights into Moda Health’s performance in this regard.

Moda Health Insurance: Pioneering Wellness with Advanced Digital and Technological Features

Mobile App Features and Functionality

Moda Health offers a mobile app that provides policyholders with convenient access to their insurance information and various features.

While the article does not detail the specific features and functionality of the app, you can explore Moda Health’s official website or app store listings to learn more about what the mobile app offers. Look for features like digital ID cards, claims tracking, and provider searches.

Online Account Management Capabilities

Policyholders with Moda Health can enjoy robust online account management capabilities. These features typically include the ability to view and manage your policy, track claims, make premium payments, and access important documents. The availability and functionality of online account management tools can significantly enhance your overall insurance experience.

Digital Tools and Resources

In addition to the mobile app and online account management, Moda Health may provide digital tools and resources to help policyholders make informed decisions about their healthcare and insurance coverage.

These tools could include cost calculators, provider directories, wellness resources, and educational materials. Exploring Moda Health’s official website and customer portal will give you a better understanding of the digital tools available to policyholders.

What do the ratings and consumer reviews say about the company?

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, which should have a fairly large customer service department.

Moda does not appear on any of the major review sites or the review directory, 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, Inc. has not been in the health insurance market for very long.

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

What is 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.