Health Plan-Moda - Insurance Partners NW

Health Plan-ModaModa Select 2016 PlansCompared
COMPANY Moda Moda Moda Moda Moda Moda
Plan BeProtected BePrepared StandardSilver Be SupportedCCN Standard
Bronze
BeLively
MetalTier Gold Silver Silver Silver Bronze
(HASEligible)
Bronze
Deductible $1,000 $1,550 $2,500 $2,500 $5,000 $5,500
Co-insurance 15% 30% 30% 35% 0% 40%
Maximum Out ofPocket (InNetwork) $5,500 $6,850 $6,850 $6,500 $6,350 $6,850
PCP/Spec.copay $15/$15 $30/$30 $35/$70 $30/$60 ded $80
Urgent Carevisit $15 $30 $90 $30 ded $100
 
AlternativeCare
 
$15/$1000max
 
$30 visit/$1000max
 
na
 
na
 
na
 
40%
PrescriptionDrug $2/$10/40%/50% $2/$20/40%/50% $15/$15/$50/50% $2/$10/40%/50% ded $2/$10/ded/ded
Mental Healthvisit $15 $30 $35 $30 ded $80
Network Beacon Beacon Beacon CCN Beacon RoseCity
Non-Smoker, area 1rates Monthly Monthly Monthly Monthly Monthly Monthly
20 &Under $183 $161 $152 $143 $125 $113
21 $289 $254 $240 $226 $197 $178
22 $289 $254 $240 $226 $197 $178
23 $289 $254 $240 $226 $197 $178
24 $289 $254 $240 $226 $197 $178
25 $290 $255 $241 $227 $198 $179
26 $296 $260 $246 $231 $201 $183
27 $302 $266 $251 $237 $206 $187
28 $314 $276 $261 $245 $214 $194
29 $323 $284 $269 $253 $220 $200
30 $328 $288 $272 $256 $223 $202
31 $334 $294 $278 $262 $228 $207
 
32 $341 $300 $284 $267 $223 $211
33 $346 $304 $287 $270 $236 $214
34 $350 $308 $291 $274 $239 $217
35 $353 $310 $293 $276 $240 $218
36 $355 $312 $295 $278 $242 $219
37 $357 $314 $297 $279 $244 $221
38 $360 $316 $299 $281 $245 $222
39 $364 $320 $303 $285 $248 $225
40 $369 $324 $307 $288 $251 $228
41 $376 $330 $312 $294 $256 $232
42 $382 $336 $318 $299 $261 $236
43 $392 $344 $326 $306 $267 $242
44 $403 $354 $335 $315 $275 $249
45 $417 $366 $347 $326 $284 $258
46 $433 $380 $360 $339 $295 $268
47 $451 $396 $375 $353 $308 $279
48 $472 $415 $392 $369 $322 $292
49 $492 $433 $409 $385 $336 $304
50 $515 $453 $429 $403 $351 $319
51 $538 $473 $448 $421 $367 $333
52 $563 $495 $468 $441 $384 $348
53 $589 $517 $490 $460 $401 $364
54 $616 $542 $512 $482 $420 $381
55 $644 $566 $535 $503 $439 $398
56 $673 $592 $560 $527 $459 $416
57 $703 $618 $585 $550 $480 $435
58 $735 $646 $611 $575 $501 $454
59 $751 $660 $625 $588 $512 $464
60 $783 $688 $651 $613 $534 $484
61 $811 $713 $674 $634 $553 $501
62 $829 $729 $689 $648 $565 $512
63 $852 $749 $708 $666 $581 $527
64 $866 $761 $720 $677 $590 $534

 
 
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