Moda Health Plans - TEXAS
About Moda
Moda individual medical plans give access to providers in the Moda Select Network. This network includes a group of licensed medical professionals, clinics, pharmacies, labs and hospitals. These providers offer quality care and services to Individual members who live within the Hays, Travis, and Williamson service area.
EPO Plans
Moda’s network of healthcare providers offers the right combination of value and service. No referrals are needed for in-network specialist care. Please note that there is no out-of-network coverage, except for emergency medical care and retail pharmacy services, and some out-of-area children.
In network providers and health systems
Serving Hays, Travis and Williamson counties in the greater Austin area, the network is made of a carefully selected community of PCPs, specialists and partner health systems, including:
- Austin Diagnostic Clinic
- Austin Regional Clinic
- Capital Area Cardiology
- Capital Area Multispecialty Providers
- Capital Area Primary Care
- Capital Area Specialty Providers
- St. David’s HealthCare
Pharmacy benefits
In-network pharmacies
- The pharmacy network includes access to over 95% of pharmacies in Texas, plus more than 65,000 pharmacies nationwide. This means you can fill prescriptions almost anywhere, including these local and national drug store chains.
- Locate in-network pharmacies
- Mail-order services If you have a chronic health condition, our mail-order services via Costco and PPS may be for you.
- Covered prescription drugs
And you can review our Texas specific formulary (list of covered prescription drugs) to see if any current prescriptions are covered in our plans. - Search for covered medications
Are some services available out-of-network?
Yes! Out-of-network care is covered for medical emergency services, retail pharmacy services, and services at an in-network facility when you cannot choose an in-network provider.
I’m traveling outside the service area. Can I still get medical care?
Yes! Access the same in-network benefits you enjoy in Texas when you travel to Moda Select service areas in Alaska and Idaho. Outside of the Moda Select service areas, members are covered for medical emergency services and urgent care through the First Health Network.
Moda Health Bronze Plans Comparison
| Benefit | Standard Bronze | Bronze 8700 | Bronze HDHP 7500 |
|---|---|---|---|
| Plan Summary of Benefits | Download PDF Here | Download PDF Here | Download PDF Here |
| Deductible (Ind / Fam) | $7,500 / $15,000 | $8,700 / $17,400 | $7,500 / $15,000 |
| Out-of-Pocket Max (Ind / Fam) | $10,000 / $20,000 | $9,100 / $18,200 | $7,500 / $15,000 |
| Primary Care Visit | $50 copay (no deductible) | 50% coinsurance | $0 after deductible |
| Specialist Visit | $100 copay (office) / $50 virtual | 50% coinsurance | $0 after deductible |
| Urgent Care Visit | $75 office / $50 virtual | 50% coinsurance | $0 after deductible |
| Virtual Care Visit | $50 copay | 50% coinsurance | $0 after deductible |
| Emergency Room Visit | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| Prescription Drugs | |||
| Value Tier | $25 retail / $75 mail | $25 retail / $75 mail | $25 retail / $75 mail |
| Select (Generic) | $25 retail / $75 mail | $25 retail / $75 mail | $25 retail / $75 mail |
| Preferred Brand | $50 retail / $150 mail | $50 retail / $150 mail | $50 retail / $150 mail |
| Non-Preferred Brand | $100 retail / $300 mail | $100 retail / $300 mail | $100 retail / $300 mail |
| Preferred Specialty | $500 copay | $500 copay | $500 copay |
| Non-Preferred Specialty | Not covered | Not covered | Not covered |
Moda Health Silver/Gold Plans Comparison
| Benefit | Standard Silver | Standard Gold |
|---|---|---|
| Plan Summary of Benefits | Download PDF Here | Download PDF Here |
| Deductible (Ind / Fam) | $6,000 / $12,000 | $2,000 / $4,000 |
| Out-of-Pocket Max (Ind / Fam) | $8,900 / $17,800 | $8,200 / $16,400 |
| Primary Care Visit | $40 copay (office or virtual) | $30 copay (office or virtual) |
| Specialist Visit | $80 office / $40 virtual | $60 office / $30 virtual |
| Urgent Care Visit | $60 office / $40 virtual | $45 office / $30 virtual |
| Virtual Care Visit | $40 copay | $30 copay |
| Emergency Room Visit | 40% coinsurance | 25% coinsurance |
| Prescription Drugs | ||
| Value Tier | $20 retail / $60 mail | $15 retail / $45 mail |
| Select (Generic) | $20 retail / $60 mail | $15 retail / $45 mail |
| Preferred Brand | $40 retail / $120 mail | $30 retail / $90 mail |
| Non-Preferred Brand | $80 retail / $240 mail | $60 retail / $180 mail |
| Preferred Specialty | $350 copay | $250 copay |
| Non-Preferred Specialty | Not covered | Not covered |
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Moda Coverage Map
