Oregon health plan · 2026

Moda Health Affinity Gold 1500 · 39424OR1680008

Moda Health Plan, Inc offers this marketplace health insurance plan (Plan ID 39424OR1680008) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: EPO CSR: Standard Gold On Exchange Plan Issuer: Moda Health Plan, Inc
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 78.93%. Expect to pay roughly 21.07% of covered costs out of pocket, based on issuer reporting.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$312 – $1830

Before subsidies

Estimate after subsidies

Deductible

$1,500

$3000 per group

See deductible details

Max out-of-pocket

$7,900

$15800 per group

Review MOOP rules

Office visits

Primary care $15.00
Specialist $30.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand 40.00%

View formulary tiers

$614 / mo before subsidies

≈ $7368 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1630 / mo before subsidies

≈ $19560 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1970 / mo before subsidies

≈ $23640 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1258 / mo before subsidies

≈ $15096 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Oregon). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Gold On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 39424OR1680008
Coverage year 2026
State Oregon
Issuer Moda Health Plan, Inc
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 39424OR1680008-01
Available variants

Standard Off Exchange Plan · 39424OR1680008-00

Standard On Exchange Plan · 39424OR1680008-01

Open to Indians below 300% FPL · 39424OR1680008-02

Open to Indians above 300% FPL · 39424OR1680008-03
Last plan update Tue, 21 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Oregon 28171
PCPs in Oregon 3043
Telehealth support Data pending
Nationwide providers 100504
28,171 doctors statewide 3,043 PCPs 145 OB/GYN

Provider network(s)

Providers Oregon All US states
All 28171 100504
PCP 3043 4566
Allergy 10 12
OB/GYN 145 198
Dentists 48 60

Drug coverage overview

5,735 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC 2,525
SPECIALTY-DRUGS 1,538
NON-PREFERRED-BRAND 1,211
ZERO-COST-PREVENTIVE-DRUGS 461
Prior authorization Drugs
Required 1,333
Not Required 4,402
Step therapy Drugs
Required 695
Not Required 5,040
Quantity limits Drugs
Has Limit 2,597
No Limit 3,138

Customer highlights

What stands out for members

  • Issuer: Moda Health Plan, Inc · Plan ID 39424OR1680008 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 39424OR1680008-01 (Standard On Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Plan uses the term "spinal manipulation." Other services such as lab and diagnostic x-rays are under the Plan’s standard benefit for the type of service provided.

Diabetes Education

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 3.0 Hours per Year

Covers three hours of education per year if there is a significant change in condition or treatment; covers one diabetes self-management education program at the time of diagnosis.

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Laboratory Outpatient and Professional Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met.

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

7 exams ages 1 to 4 and one per year age 5 and over. See policy for other visit limits.

Primary Care Visit to Treat an Injury or Illness

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Additional 30 visits for neurological conditions. Visit limits do not apply to mental health and substance use disorder services.

Rehabilitative Speech Therapy

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Additional 30 visits for neurological conditions. Visit limits do not apply to mental health and substance use disorder services.

Specialist Visit

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Includes office visits by naturopathic physicians.

Telehealth - Primary Care

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Telehealth - Specialist

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Zero Cost Share Preventive Drugs

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Include prescribed preventive medications under the Affordable Care Act

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Durable Medical Equipment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Emergency Room Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Respite care provided in a nursing facility subject to a maximum of five consecutive days and to a lifetime maximum benefit of 30 days.

Inpatient Hospital Services (e.g., Hospital Stay)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Additional 30 visits for neurological conditions. Visit limits do not apply to mental health and substance use disorder services.

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met.

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Authorized transplant facility only. $7,500 maximum for travel and housing per transplant.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

1 hearing aid per hearing impaired ear if prescribed, fitted, and dispensed by a licensed audiologist with the approval of a licensed physician. Coverage will be provided every 3 years as medically necessary for the treatment of a member's hearing loss.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

1 exam per year for members through the end of the month in which they reach age 19.

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

1 in-hospital newborn visit and 6 additional visits for the first year of life.

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network $10.00

Retail up to 30-day supply and mail order up to 90-day supply per prescription. One copay for a 30-day supply. Insulin member cost share maximum of $35 for a 30-day supply. Known as the Select tier in the plan, and it includes generic medications that represent the most cost effective option, as well as certain cost effective brand medications.

Medical Service Drugs

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Non-Preferred Brand Drugs

50.00%
Tier 1 in-network 50.00%
Out-of-network 50.00%

Retail up to 30-day supply and mail order up to 90-day supply per prescription. Insulin member cost share maximum of $35 for a 30-day supply. Known as the Non-preferred tier in the plan, and these medications do not have significant therapeutic advantage over their preferred alternatives. These products generally have safe and effective options available under the Value, Select and/or Preferred tiers.

Preferred Brand Drugs

40.00%
Tier 1 in-network 40.00%
Out-of-network 40.00%

Retail up to 30-day supply and mail order up to 90-day supply per prescription. Insulin member cost share maximum of $35 for a 30-day supply. Known as the Preferred tier in the plan, and it includes generic medications that have no more favorable outcomes, from a clinical perspective, than other more cost effective generic medications.

Specialty Drugs

40.00%
Tier 1 in-network 40.00%
Out-of-network 100.00%

Up to 30-day supply per prescription at designated specialty pharmacies only.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

For treatment within 12 months of the date of injury to restore teeth to a functional state.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hormone Therapy

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Some medications may be limited to certain providers or settings.

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Authorization required after first 5 visits.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Acupuncture

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 12.0 Visit(s) per Year

Other services such as lab and diagnostic x-rays are under the Plan’s standard benefit for the type of service provided.

Allergy Testing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Other medically necessary diagnostic services provided in a hospital or outpatient setting, including testing or observation to diagnose the extent of a medical condition.

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cosmetic Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Benefit is limited to one attempt at cosmetic or reconstructive surgery when necessary to correct a functional disorder; or when necessary because of an accidental injury, or to correct a scar or defect that resulted from treatment of an accidental injury; or when necessary to correct a scar or defect on the head or neck that resulted from a covered surgery.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

1 pair of glasses for members through the end of the month in which they reach age 19. Contact lenses covered in lieu of eyeglasses.

Gender Affirming Care

Coverage details pending

Gender affirming care is covered when determined by a provider as medically necessary and follows accepted standards of care. Please check with the insurance carrier for coverage information, including any limitations and exclusions.

Habilitation Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to mental health and substance use disorder services.

Imaging (CT/PET Scans, MRIs)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Non-Preferred Generic

$10.00
Tier 1 in-network $10.00
Out-of-network $10.00

Retail up to 30-day supply and mail order up to 90-day supply per prescription. One copay for a 30-day supply. Insulin member cost share maximum of $35 for a 30-day supply. Known as the Select tier in the plan, and it includes generic medications that represent the most cost effective option, as well as certain cost effective brand medications.

Preferred Generic

$2.00
Tier 1 in-network $2.00
Out-of-network $2.00

Retail up to 30-day supply and mail order up to 90-day supply per prescription. One copay for a 30-day supply. Insulin member cost share maximum of $35 for a 30-day supply. Known as the Value tier in the plan, and it includes commonly prescribed medications used to treat chronic medical conditions.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limited to one attempt at cosmetic or reconstructive surgery when necessary to correct a functional disorder; or when necessary because of an accidental injury, or to correct a scar or defect that resulted from treatment of an accidental injury; or when necessary to correct a scar or defect on the head or neck that resulted from a covered surgery.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Benefit is limited to persons with a medical condition that requires it.

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Variant attributes

Moda Health Affinity Gold 1500 · Variant 39424OR1680008-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

39424OR168

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

39424OR1680008-01

Plan Marketing Name

Moda Health Affinity Gold 1500

Plan Variant Marketing Name

Moda Health Affinity Gold 1500

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

78.93%

Issuer ID

39424

Issuer Marketplace Marketing Name

Moda Health Plan, Inc.

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

Yes

Network ID

ORN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency care only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergent and non-emergent care when using an in-network provider

Service Area ID

ORS002

State Code

OR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$2,200

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$1,500

SBC Scenario, Having Diabetes, Coinsurance

$1,700

SBC Scenario, Having Diabetes, Copayment

$200

SBC Scenario, Having Diabetes, Deductible

$400

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$200

SBC Scenario, Treatment of a Simple Fracture, Copayment

$100

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$15800 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$7900 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,900

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ORF002

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$50

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

3

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

0.9986

First Tier Utilization

100%

Import Date

10/21/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

EPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

39424OR1680008

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$3000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$1500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$1,500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Oregon?

Moda Health Affinity Gold 1500 (39424OR1680008) is a Gold EPO from Moda Health Plan, Inc in Oregon for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Moda Health Affinity Gold 1500 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Moda Health Affinity Gold 1500 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Moda Health Affinity Gold 1500 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Moda Health Affinity Gold 1500?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Moda Health Affinity Gold 1500?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency care only

Does Moda Health Affinity Gold 1500 cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergent and non-emergent care when using an in-network provider

How do I enroll in or manage payments for Moda Health Affinity Gold 1500?

Use the issuer portal https://modahealth.com/members/ebill.shtml to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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