Moda Health Insurance Coverage for Addiction Treatment

Moda Health was founded as a part of the Oregon Dental Society (ODS) in 1955 and changed its name to Moda Health in 2013. Today they offer both medical and dental insurance in four states: Oregon and Alaska along with Idaho and Texas.

Plans from Moda are available to individual and families as well as to employers. Their plans include regular medical plans and Medicare plans as well as dental coverage.

Moda Health serves over 430,000 with their medical plans and over 750,000 with their pharmacy coverage. They also have 1.3 million members in their dental plans.

Does Moda Health Cover Addiction Rehab?

The Affordable Care Act requires that most insurance policies cover mental and addiction treatment, but every policy is different. You can learn your exact amounts based on your policy by discussing it with the treatment center.

Insurance often focuses on medically necessary treatment like detox and medication. If you don’t have a specific treatment plan in place, reach out to a qualified healthcare professional to create a long-term plan to submit to your insurance.

What Are Moda Health Plans?

Moda Health offers insurance plans on the state Insurance Marketplace in four states and they have Medicare plan options. They also have insurance plans that small and large employers can offer to their employees.

The individual and family plans on the Marketplace or from employers may offer a variety of benefits including addiction treatment. Most Moda plans are preferred provider organization (PPO) plans. With a PPO you don’t need a referral to see a specialist like an addiction counselor or therapist and you can get coverage for out of network providers. However if you do go out of the network you will pay a lot more out of pocket.

Moda Health also has Medicare plans. If you have Original Medicare you can get a Medicare supplement plan to help you cover out of pocket costs like coinsurance. Another option is to replace Original Medicare with a Moda Medicare Advantage plan with gives you Medicare coverage with additional benefits.

Finally Moda Health partners with Delta Dental to offer dental coverage to over 1 million members.

What Perks Are Available With Moda Health Insurance Plans?

While not all plans have the same benefits, Moda Health Insurance offers some extra perks to members that may be hard to find with other companies.

For example, there’s the CirrusMD app that allows you to contact a doctor by text, 24/7, without an appointment. You can message, share videos, and share photos in order to get more information about urgent or general health questions.

They also offer IDX Identity at no cost to help you protect your identity, including MIDAS technology that monitors health claims to detect any fraud or theft being done in your name. This gives you priceless peace of mind.

What Inpatient Rehab Does Moda Health Cover?

Most Moda Health plans cover at least some of the cost of inpatient rehab. Insurance companies focus on medically necessary care, so you must have a treatment plan from a qualified professional to show what levels of care you need for substance use treatment.

It’s also important to get the full details of your plan to ensure you get a referral or preauthorization if needed before you begin treatment.

Medical detox is one important part of inpatient care on the journey to recovery. Under a doctor’s care, you can better deal with withdrawal systems and any other negative effects of coming off the substance.

Inpatient and residential care provides an intensive, focused, structured treatment journey. It also includes access to healthcare workers and counselors who can help with any problems you face.

What Outpatient Addiction Treatment Does Moda Health Cover?

There are several types of outpatient treatment. Partial hospitalization programs (PHP) typically require at least 30 hours of commitment each week and are often known as day programs. They have a similar intensity as inpatient or residential rehab but you go home in the evenings.

Intensive outpatient programs (IOP) are more flexible, requiring about three three-hour sessions per week. You can often choose to go in the morning, afternoon, or evening depending on your work or school commitments.

General outpatient care is far less intensive than other programs. You’ll get one or two sessions per week that are about an hour each.

Does Moda Health Cover Methadone & Suboxone (MAT)?

Some Moda plans cover medically assisted treatment (MAT). Certain medications have been approved by the FDA for use in the help of recovery.

Two of these are suboxone and methadone, designed to help those struggling with an opioid addiction. At most treatment centers, you’ll have access to a doctor who can discuss if these medications are right for you, but make sure your insurance policy covers the cost and you have any referrals and preauthorizations in place before you start.

Does Moda Health Cover Other Mental Healthcare?

Most insurance plans cover mental health care because of the Affordable Care Act, but you’ll want to make sure to check your individual health plan. This can help you get treatment for diagnoses like depression, anxiety, or other concerns.

Substance abuse disorders often co exist with additional mental health problems like depression, anxiety, and PTSD. To establish long-term recovery, you will need to treat your mental health and substance use together. Fortunately, most Moda plans will cover this type of integrated treatment.

How Long Will Moda Health Cover Rehab?

Because every addiction is different and every person is unique, the length of treatment is determined by medical need. Your specific insurance plan may have its own requirement and limits as well. Your doctor will be actively involved in helping you determine what treatment to pursue, whether it’s inpatient or outpatient.

The best way to have a successful treatment journey and reach lifetime recovery is to follow through on each step of your treatment plan. Be committed to doing the work needed to create new habits and mindsets and you’ll enjoy the fruit of having a life you love.

Does Addiction Treatment Need to Be In Network?

Because most Moda plans use a preferred provider organization (PPO) network, there is likely to be coverage for out-of-network providers. However the costs are much higher.

If you choose to see someone out of network, your copayments and deductibles increase significantly, so it’s a good idea to look for a treatment center in network if possible.

How to Verify Coverage With Moda Health

Login to the helpful member dashboard or contact a customer service representative to get full details about your plan, including requirements and in-network providers.

You can also discuss your insurance plan with the treatment center. While they can give you a general idea of what treatment costs, remember that your insurance company has the final say, so they are the most reliable option. Make sure to mention your specific plan name rather than just Moda Health because every policy is different.