We offer Medicare Supplement Plans A, F, High-deductible F, G, High-deductible G and N. The following is a breakdown of the basic benefits covered by all plans and additional benefits that are plan-specific.

All of our Medicare Supplement plans offer basic benefits that help pay for Medicare-eligible hospital and physician expenses.

A summary of each plan is listed below. For more detailed information about these plans and rates, see our Medicare Supplement brochure. If you are ready to enroll, you can also download our application.

If you have questions about our plans or would like to request a free Moda Health Medicare Supplement enrollment packet, please call us toll-free at 855-718-1767. You can also send us an email with your questions or request for more information.

We also offer individual dental plans.

Learn more about our Medicare Supplement plans:

• Plan options
• Extra benefits and features
• Frequently asked questions
• How to enroll

Plan options

Plan A

• Basic benefits
• Your Medicare Part A coinsurance for hospital care, PLUS coverage for 365 additional days after Medicare benefits end
• The first three pints of blood each year
• Coverage for the Part B coinsurance amount (generally 20 percent of Medicare- approved expenses) after the annual deductible is met

Plan F or Plan High-deductible F

• Basic benefits
• Same as Plan A
• Additional benefits
• Foreign travel emergency care – after a $250 calendar year deductible, pays 80 percent of eligible expenses for a lifetime maximum of $50,000
• Part A and B deductible
• Skilled nursing facility – coinsurance for Medicare-approved stays of 100 days or less
• Part B excess physician charges – pays 100 percent of the difference between what Medicare pays and the maximum amount the doctor or provider can charge Medicare patients for covered services
• $2,490 deductible option available with Plan High-deductible F

Plan G or Plan High-deductible G

• Basic benefits
• Same as Plan A
• Additional benefits
• Foreign travel emergency care – after a $250 calendar year deductible, pays 80 percent of eligible expenses for a lifetime maximum of $50,000
• Part A deductible
• Skilled nursing facility – coinsurance for Medicare-approved stays of 100 days or less
• Part B excess physician charges – pays 100 percent of the difference between what Medicare pays and the maximum amount the doctor or provider can charge Medicare patients for covered services
• $2,490 deductible option available with Plan High-deductible G

Plan N

• Basic benefits
• Same as Plan A
• Additional benefits
• Foreign travel emergency care – after a $250 calendar year deductible, pays 80 percent of eligible expenses for a lifetime maximum of $50,000
• Part A deductible
• Skilled nursing facility – coinsurance for Medicare-approved stays of 100 days or less
• The lesser of $20 or the Part B coinsurance for office visits and the lesser of $50 or the Part B coinsurance for emergency room visits after the Part B deductible is met

Extra benefits and features

It is important to us to provide you with the best health plans possible, matched by the best customer service possible. That's why we've added extra benefits for added convenience:

• Electronic claims filing. At no extra cost, Medicare Part B claims will be forwarded directly to Moda Health after Medicare pays its share. You will know that a bill was submitted directly to Moda Health because it will have the following statement printed on the bottom: THIS CLAIM HAS BEEN FORWARDED TO YOUR SECONDARY MEDICARE PAYOR. Moda Health will send you an Explanation of Benefits (EOB) indicating the amount paid or payment to you if you are being reimbursed.
• No claim forms. If you have a claim, just mail a copy of the Explanation of Medicare Benefits (EOMB) form you receive from Medicare to us. We'll do the rest.
• Benefit and information updates. Your Moda Health Medicare Supplement policy will automatically coordinate with changes in Medicare each year. We'll keep you informed about any changes that take place.
• Guaranteed renewable. We will never cancel your policy because of your age or claims experience.
• 30-day free look. If you're not completely satisfied with your Moda Health Medicare Supplement policy, return it to us within 30 days and receive a full refund of any premiums paid.

Frequently asked questions

• Am I eligible?
• When does coverage begin?
• Is there a waiting or an exclusion period?
• Can I see the doctors I want if I enroll in a Moda Health Medicare Supplement plan?
• Are there prescription benefits available in my Moda Health Medicare Supplement plan?
• Are there dental benefits available in my Moda Health Medicare Supplement plan?
• What is the address for filing a claim?

Am I eligible?
You can apply for coverage if you live in Oregon and are enrolled in Medicare Part A and B. This includes individuals who are under age 65 and are enrolled in Medicare because of disability. For more information regarding eligibility periods and conditions for enrollment, please download the Moda Health Medicare Supplement brochure and application for a complete description or contact us for qualifications review.

When does coverage begin?
If you apply during an open enrollment period (within six months of becoming eligible for Part B), your coverage will start the first of the month following the date we receive your application. If you do not apply during an open enrollment period, we will notify you of the date coverage will begin after your application is approved.

Is there a waiting or an exclusion period?
If you transfer directly to a Moda Health Medicare Supplement plan from a Medicare Advantage, a Medicare Supplement (Medigap) policy or other coverage, we will credit month for month the amount of time you were enrolled under one of those plans. If you were enrolled for six or more months, you will not have a six-month pre-existing waiting period.

For our individual and family dental plans, there are exclusion periods on Class 2 and Class 3 services. These exclusion periods may be waived with 12 continuous months of prior dental coverage from a comparable plan with no more than a 90-day break in coverage from the end of the old policy to the expected effective date of the new policy. Please see the dental benefit descriptions for more details on benefits with exclusion periods.

Can I see the doctors I want if I enroll in a Moda Health Medicare Supplement plan?
As a member of a Moda Health Medicare Supplement plan, you are free to choose any licensed doctor or provider for your healthcare needs.

Should you seek care from a doctor or provider who has not accepted Medicare assignment, you will be responsible for paying the difference between what Medicare pays and the maximum amount the doctor or provider can charge Medicare patients for covered services. However, using Medicare-assigned doctors and providers can reduce those out-of-pocket expenses.

Are there prescription benefits available in my Moda Health Medicare Supplement plan?
Medicare Supplement plans do not offer benefits for prescription drugs. People who want to add prescription drug coverage to their plan will need to purchase a stand-alone Prescription Drug Plan (PDP). Moda Health does not offer a stand-alone PDP. For information on the stand-alone PDPs available in your area, please visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Are there dental benefits available in my Moda Health Medicare Supplement plan?
For an additional premium, Moda Health provides Medicare Supplement plan members the opportunity to enroll in one of our individual dental plans with Delta Dental of Oregon.

What is the address for filing a claim?
Send claims to:

Moda Health Plan, Inc.
Attn: Medicare Supplement
P.O. Box 40384
Portland, OR 97240-0384

Please include the following information:

• Patient's name and ID number
• Date of treatment
• Diagnosis
• An itemized description of services and charges

If the treatment is for an accidental injury, include a statement with the date, time, place and circumstances of the accident when you send us the physician or professional provider's bill.
For Plans F, High-deductible F, G, High-deductible G and N, if you received emergent or urgent care out of the country, submit the same information indicated above to the address listed along with the following additional information in order to receive reimbursement for the expense:

• Copy of the medical record (translated is preferred, if available)
• Proof of payment in the form of a credit card/bank statement or cancelled check.

How to enroll

Moda Health Medicare Supplement enrollment

If you have questions about our plans or would like to request a free Moda Health Medicare Supplement enrollment packet, please call us toll-free at 855-718-1767. You can also send us an email with your questions or request for more information.

If you have reviewed our Medicare Supplement plans and rates, listed in our brochure and you are ready to enroll, you can also download our application, complete, sign and send it to us at:

Mail:
Moda Health Plan, Inc.
Attn: Medicare Membership Accounting
P.O. Box 40384
Portland, OR 97240-0384

Fax:
Fax a copy of your completed and signed application to 503-224-1975

Email:
Email a scanned copy of your completed and signed application to bemc@modahealth.com.