Moda Health Texas Plans 2027: Honest Review & Plan Comparison
Moda Health is a Portland, Oregon-based nonprofit insurer that expanded into the Texas individual marketplace for 2025, initially serving the Austin metro area. For 2026, Moda continues offering plans in Hays, Travis, and Williamson counties through the Moda Select network, an EPO-style network that does not require specialist referrals.
Originally founded in 1955 as the Oregon Dental Service, Moda has grown into a full-service health plan covering over 1 million members across the Pacific Northwest. Their Texas expansion brings a different approach: competitive copay structures, $0 virtual urgent care on select plans via CirrusMD, and in-network benefits extending to Alaska and Idaho for members who travel.
What Makes Moda Different in Texas?
- No referrals needed: See any in-network specialist directly, no primary care gatekeeper
- $0 virtual urgent care: Available on all off-exchange "Direct" plans through CirrusMD, 24/7
- Nonprofit insurer: Moda reinvests surplus into member services rather than shareholder dividends
- 95%+ TX pharmacy coverage: Nearly every pharmacy in Texas is in-network
- Multi-state in-network benefits: Coverage extends to Alaska and Idaho provider networks for 2026
2027 Moda Health Texas Plans at a Glance
Moda offers 10 individual plans in Texas for 2026: 5 available on the marketplace (subsidy-eligible) and 5 off-exchange only.
Marketplace Plans (Subsidy-Eligible)
| Plan Name | Metal | Deductible | Max OOP | PCP Copay | Specialist |
|---|---|---|---|---|---|
| Standard Gold | Gold | $2,000 | $8,200 | $30 | $60 |
| Standard Silver | Silver | $6,000 | $8,900 | $40 | $80 |
| Standard Bronze | Bronze | $7,500 | $10,000 | After ded | After ded |
| Bronze HDHP 7500 HSA-eligible | Bronze | $7,500 | $7,500 | After ded | After ded |
| Bronze 8700 $0 Virtual UC | Bronze | $8,700 | $8,700 | After ded | After ded |
Off-Exchange Plans (All Include $0 Virtual Urgent Care via CirrusMD)
| Plan Name | Metal | Deductible | Max OOP |
|---|---|---|---|
| Gold 1000 Direct | Gold | $1,000 | $8,000 |
| Gold 2000 Direct | Gold | $2,000 | $7,900 |
| Silver 3000 Direct | Silver | $3,000 | $8,500 |
| Silver 5000 Direct | Silver | $5,000 | $7,750 |
| Silver 7000 Direct | Silver | $7,000 | $8,000 |
Head-to-Head: Standard Gold vs. Standard Silver
These are Moda's two most popular marketplace plans in Texas. Use the toggle below to compare them side by side.
Moda Select Texas Standard Gold
✓ Strengths
- Lowest deductible of any Moda marketplace plan
- $30 PCP copays mean affordable routine visits
- Drug copays don't require meeting deductible first (generics & preferred brands)
- No referrals needed to see specialists
- Subsidy-eligible, can be very affordable with APTC
✗ Watch Out For
- 25% coinsurance on ER and inpatient adds up fast on big claims
- $8,200 max OOP is higher than some competing Gold plans
- EPO network: no out-of-network coverage except emergencies
- Limited to Austin metro area (Hays, Travis, Williamson counties)
- No dental or vision included
Moda Select Texas Standard Silver
✓ Strengths
- Lower monthly premium than Gold, good if you're healthy and rarely use care
- PCP and generic Rx copays work without hitting deductible first
- CSR variants (73%, 87%, 94%) drastically reduce costs if income qualifies
- Same no-referral specialist access as Gold
- Subsidy-eligible through the marketplace
✗ Watch Out For
- $6,000 deductible is steep, ER and hospital stays are expensive until you hit it
- 40% coinsurance after deductible is among the highest in Silver plans
- Non-preferred brand and specialty drugs require meeting deductible first
- $80 specialist copays are higher than competing Silver plans
- Same limited Austin-area network as all Moda TX plans
Our Honest Take on Moda Health in Texas
Moda brings something genuinely different to the Texas marketplace. As a nonprofit with decades of experience in Oregon, they're not a fly-by-night startup, but they are brand new to Texas, and that matters.
The good: Moda's plan designs are competitive, especially the Standard Gold. A $2,000 deductible with $30 PCP copays is solid for a Gold EPO. The no-referral policy saves time and hassle if you need specialist care, and the drug copay tiers are reasonable. Their off-exchange Direct plans are particularly interesting, the Gold 1000 Direct ($1,000 deductible, $8,000 OOP) is one of the richest individual plans available in the Austin area.
The concern: Moda's Texas network is still being built. They're only in three counties, and while they've partnered with Baylor Scott & White and other major Austin-area providers, the network is smaller than established carriers like BCBS or Ambetter. If you travel frequently within Texas or need care in Dallas, Houston, or San Antonio, you won't have in-network options outside of emergencies.
Bottom line: If you live in the Austin metro and want a well-structured plan from a nonprofit insurer, Moda is worth quoting. The Standard Gold is the standout plan for people who use their insurance regularly. The Silver is decent but gets significantly better with Cost-Sharing Reductions if your income qualifies. For healthy people who want the lowest premium, the off-exchange Silver 5000 Direct is worth a look for its $0 virtual urgent care perk.
Who Should Consider Moda Health?
- Austin-area residents in Travis, Williamson, or Hays County
- People who want nonprofit coverage without the BCBS premium price tag
- Families and individuals who value direct specialist access without referral hassles
- Anyone eligible for subsidies: Moda marketplace plans qualify for APTC and CSR
Get Your Personalized Moda Health Quote
Plan pricing depends on your age, location, household size, and income. Enter your ZIP code below to see exactly what Moda plans cost in your area, and whether you qualify for premium subsidies that can reduce your monthly cost to as low as $0.
