Moda Pioneer Alaska Standard Bronze - 73836AK0960001 Health Insurance Plan
Moda Health Plan, Inc. health insurance plan with the Plan ID 73836AK0960001. The plan is called Moda Pioneer Alaska Standard Bronze.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.81% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.19% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 73836AK0960001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Alaska | ||||||||||||||||||
| Health Insurance Issuer | Moda Health Plan, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 73836AK0960001-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED NON-PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Sep 2025 15:17 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 73836AK0960001-00 Standard On Exchange Plan - 73836AK0960001-01 |
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| Last Plan Update Date | Sat, 11 Jan 2025 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Sep 2025 15:17 GMT |
Benefits of Moda Pioneer Alaska Standard Bronze Health Insurance Plan, 73836AK0960001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Accidental Dental
Exclusions: nan Services must begin within 12 months of the date of injury; diagnosis made within 6 months of date of injury. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Acupuncture
Limit: 24.0 Visit(s) per Year Exclusions: nan Services must be medically necessary to relieve pain, induce surgical anesthesia, or to treat a covered illness, injury or condition. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Allergy Testing
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan Frequency limits apply to some services. |
YES | 10.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Chemotherapy
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Chiropractic Care
Limit: 24.0 Visit(s) per Year Exclusions: nan Plan uses the term "spinal manipulation." Other services such as lab and diagnostic x-rays are under the Plans standard benefit for the type of service provided. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Dental Check-Up for Children
Exclusions: nan 1 exam and cleaning every 6 months. |
YES | 0.00% |
60.00% Coinsurance after deductible |
| Diabetes Education
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Dialysis
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Durable Medical Equipment
Exclusions: nan Orthotics or orthopedic shoes are covered when medically necessary. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Emergency Room Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance
Exclusions: nan Air and Ground transpiration benefit is limited to medical emergency. Ambulance services is separate benefit, covers both medical emergency transport and non-emergent transport. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Eye Glasses for Adults
Exclusions: nan 1 pair of lenses per year and 1 pair of frames every 2 years. In-network benefits up to $130 maximum. |
YES | $25.00 |
50.00% |
| Eye Glasses for Children
Exclusions: nan 1 pair of glasses per year. Frames from the Otis & Piper collection only. |
YES | 0.00% |
50.00% |
| Gender Affirming Care
Exclusions: nan Information about gender affirming care can be found in the policy. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Generic Drugs
Exclusions: nan Up to 90-day supply per prescription. One copay per a 30-day supply. Select tier includes generic medications that represent the most cost effective option, as well as certain cost effective brand medications. |
YES | $25.00 |
$25.00 |
| Habilitation Services
Limit: 45.0 Visit(s) per Year Exclusions: nan Habilitation includes physical, speech and occupational therapy combined, subject to an annual visit limit except for care for autism spectrum disorders provided for members under age 21. Limits apply separately to rehabilitative and habilitative services. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Hearing Aids
Exclusions: nan $3,000 maximum every 3 years |
YES | 20.00% |
20.00% |
| Home Health Care Services
Limit: 130.0 Visit(s) per Year Exclusions: nan 130 visits per applies to home visits of a home health care provider or one or more: registered nurse; a licensed practical nurse; a licensed physical therapist or occupational therapist; a certified respiratory therapist; a speech therapist certified by the American Speech, Language, and Hearing Association; a home health aide directly supervised by one of the above providers; and a person with a master's degree in social work. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Hospice Services
Limit: 6.0 Months per Lifetime Exclusions: nan Inpatient hospice care up to a maximum of 10 days. Respite care, up to a maximum of 240 hours, to relieve anyone who lives with and cares for the terminally ill member. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan Frequency limits apply to some services. |
YES | 40.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Massage Therapy
Limit: 24.0 Visit(s) per Year Exclusions: nan Prior authorization is required. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan In-network: Office visits and intensive outpatient visits $50 copay; other outpatient services 50% after deductible. / For Zero Cost Sharing plans: All outpatient visits $0 copay. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs
Exclusions: nan Up to 90-day supply per prescription. One copay per a 30-day supply. Non-preferred brand 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. |
YES | $100.00 Copay after deductible |
$100.00 Copay after deductible |
| Nutritional Counseling
Exclusions: nan Covered for some medical conditions. Prior authorization required after first 5 visits. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan Medically necessary repair of disabling malocclusion or cleft palate and severe craniofacial defects impacting function of speech, swallowing and chewing. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan Covered only when the provider is licensed to practice where the care is provided, is providing a service within the scope of that license, is providing a service or supply for which benefits are specified in this plan, and when benefits would be payable if the services were provided by a physician. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services
Limit: 45.0 Visit(s) per Year Exclusions: nan Outpatient rehabilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, subject to an annual visit limit except for care for autism spectrum disorders provided for members under age 21. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. A 'visit' is a session of treatment for each type of therapy. Each type of therapy combined accrues toward the above visit maximum. Multiple therapy sessions on the same day will be counted as 1 visit, unless provided by different health care providers. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Preferred Brand Drugs
Exclusions: nan Up to 90-day supply per prescription. One copay per a 30-day supply. Preferred tier includes generic medications that have no more favorable outcomes, from a clinical perspective, than other more cost effective generic medications. |
YES | $50.00 Copay after deductible |
$50.00 Copay after deductible |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Preventive Care/Screening/Immunization
Exclusions: nan Preventive exams: 3 exams age 2-4; one exam per year age 5 and over. Newborn Hearing Screening within 30 days of birth and additional tests up to age 24 months. Routine Vision Screening age 3-5. |
YES | 0.00% |
60.00% Coinsurance after deductible |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan nan |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan Benefit limited to initial purchase of prosthetic; does not cover replacement unless the existing device can't be repaired, or replacement is prescribed by a physician because of a change in your physical condition. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Radiation
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Reconstructive Surgery
Exclusions: nan Breast reconstruction allowed. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 45.0 Visit(s) per Year Exclusions: nan Visit limit for physical, speech, and occupational therapy services combined. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy
Limit: 45.0 Visit(s) per Year Exclusions: nan Visit limit for physical, speech, and occupational therapy services combined. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan 1 exam per year |
YES | $10.00 |
50.00% |
| Routine Eye Exam for Children
Exclusions: nan 1 exam per year |
YES | $0.00 |
50.00% |
| Routine Foot Care
Exclusions: nan Covered if required for the members medical condition. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Skilled Nursing Facility
Limit: 60.0 Days per Year Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Specialist Visit
Exclusions: nan In-network: Virtual care visits $50 copay; in-person visits $100 copay. / For Zero Cost Sharing plans: Virtual care and in-person visits $0 copay. / Includes office visits by naturopathic practitioners. |
YES | $100.00 |
60.00% Coinsurance after deductible |
| Specialty Drugs
Exclusions: nan Up to 30-day supply per prescription at a designated specialty pharmacy. Non-Preferred Specialty tier may have higher cost sharing. |
YES | $500.00 Copay after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan In-network: Office visits and intensive outpatient visits $50 copay; other outpatient services 50% after deductible. / For Zero Cost Sharing plans: All outpatient visits $0 copay. |
YES | $50.00 |
60.00% Coinsurance after deductible |
| Transplant
Exclusions: nan In-network level for centers of excellence. $7,500 per transplant for travel and lodging. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
NO | ||
| Urgent Care Centers or Facilities
Exclusions: nan In-network: Virtual care visits $50 copay via CirrusMD; in-person visits $75 copay. / For Zero Cost Sharing plans: Virtual care and in-person visits $0 copay. |
YES | $75.00 |
60.00% Coinsurance after deductible |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan Well Baby Exams covered for the first 24 months of life. |
YES | $0.00 |
60.00% Coinsurance after deductible |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
Moda Pioneer Alaska Standard Bronze Health Insurance Plan Variant 73836AK0960001-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.638091065338329 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze Off Exchange Plan |
| Dental Only Plan | No |
| Design Type | Design 1 |
| 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 | 0.99 |
| First Tier Utilization | 100% |
| Formulary ID | AKF015 |
| Formulary URL | URL |
| HIOS Product ID | 73836AK096 |
| Import Date | 2025-01-11 00:01:52 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 73836 |
| Issuer Marketplace Marketing Name | Moda Health Plan, Inc. |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | AKN002 |
| 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 | For emergency care during travel and for out-of-area dependents |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 73836AK0960001-00 |
| Plan Marketing Name | Moda Pioneer Alaska Standard Bronze |
| Plan Type | PPO |
| Plan Variant Marketing Name | Moda Pioneer Alaska Standard Bronze |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,700 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $7,500 |
| SBC Scenario, Having a Baby, Limit | $50 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $500 |
| SBC Scenario, Having Diabetes, Deductible | $4,500 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,300 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | AKS002 |
| Source Name | HIOS |
| Plan ID | 73836AK0960001 |
| State Code | AK |
| 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, 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), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $15000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $7500 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,500 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $45000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $22500 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $22,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $56400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $28200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $28,200 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Moda Pioneer Alaska Standard Bronze Health Insurance Plan, 73836AK0960001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Moda Pioneer Alaska Standard Bronze, 73836AK0960001 Health Insurance Plan, 73836AK0960001
-
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, 73836AK0960001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (73836AK0960001) Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs?
Does (73836AK0960001) Health Insurance Plan, Variant (73836AK0960001-00) have Out Of Country Coverage?
Does (73836AK0960001) Health Insurance Plan, Variant (73836AK0960001-00) have Out of Service Area Coverage?
Does (73836AK0960001) Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for Asthma?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for Heart disease?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for Depression?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for Diabetes?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for Low back pain?
Does Moda Pioneer Alaska Standard Bronze Health Insurance Plan, Variant (73836AK0960001-00) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 16 Sep 2025 15:17 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API