Moda Health
Moda Health is a privately held regional health insurer headquartered in Portland, Oregon, providing medical, dental, and pharmacy benefit plans to employer groups, individuals, Medicare beneficiaries, and Oregon Medicaid members across Oregon, Alaska, Texas, and Washington.
- Company typePrivate
- Founded1955
- HeadquartersPortland, United States
- Headcount1,001–5,000
- GTM typeB2B and B2C
- OfferingServices
What Moda Health does
Moda Health is a privately held, for-profit health insurance company headquartered in Portland, Oregon, operating across Oregon, Alaska, Texas, and Washington, with Idaho included in its broader service footprint. Founded in 1955 (originally as Oregon Dental Service, later rebranded to Moda Health), the company provides fully insured and self-funded group medical, dental, and pharmacy benefit plans to employer groups of all sizes, individual and family purchasers, Medicare beneficiaries, and Oregon Medicaid members through its EOCCO subsidiary. Dental plans are delivered under the Delta Dental brand in Oregon (Oregon Dental Service, dba Delta Dental Plan of Oregon) and Alaska (Delta Dental of Alaska), while pharmacy benefits flow through the Navitus network with mail-order via Costco and Postal Prescription Services. Administrative services including FSA, HRA, HSA, and COBRA are handled by its BenefitHelp Solutions subsidiary, offering a vertically integrated benefits stack for self-funded employers.
The core technology and product platform centers on Moda 360, a data-driven population health offering that integrates clinical, Social Determinants of Health, REALD, and SOGI data to support Health Navigators and Care 360 clinical teams in care coordination and outreach. Provider access is anchored by the Connexus PPO network (80+ hospitals, 26,000+ providers across Oregon, Washington, and Idaho), with the Synergy and Summit Medical Home networks providing tiered coordinated care in western and eastern Oregon respectively, and Moda Select and Pioneer networks serving Alaska. Digital self-service is delivered through Member, Employer, and Producer Dashboards, supplemented by the Find Care provider directory, Dental Tools (powered by Microsoft HealthVault), and a Healthcare Cost Estimator. Value-added services including telemedicine (CirrusMD), wellness programs (Active&Fit Direct, ChooseHealthy, Sprout at Work), hearing (TruHearing), identity protection (IDX Identity), and travel assistance (Assist America) extend the platform's scope.
Revenue is generated primarily through recurring medical, dental, and pharmacy insurance premiums across fully insured group and individual markets, plus administrative fees from BenefitHelp Solutions' third-party administration and government program contracts (Medicare Supplement, Medicare Advantage, Oregon Health Plan via EOCCO). Go-to-market combines dedicated field sales for large employer groups (51+), inside sales for small groups and individuals, and a large independent producer (broker) channel supported by an annual Producer Roadshow and the self-service Producer Dashboard. Moda Health is owned by Moda Partners, Inc., has raised approximately $205M across disclosed funding rounds (2014 and 2018), and holds NCQA accreditation across multiple plan lines.
Moda Health firmographics
Firmographics- Name
- Moda Health
- Legal name
- Moda Health Plan, Inc.
- Website
- https://modahealth.com
- Company type
- Private
- Founded year
- 1955
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- Moda Health is a privately held regional health insurer headquartered in Portland, Oregon, providing medical, dental, and pharmacy benefit plans to employer groups, individuals, Medicare beneficiaries, and Oregon Medicaid members across Oregon, Alaska, Texas, and Washington.
- Ownership category
- akta.pro rank
Where Moda Health is headquartered
LocationHeadquarters
- HQ city
- Portland
- HQ country
- United States
- HQ region
- North America
Offices3 records
Markets served
Moda Health business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Medical Insurance Premiums: Moda Health generates the majority of its revenue from medical insurance premiums collected from employer groups, individuals, and government programs (Medicare, Oregon Health Plan). Premium revenue is generated through fully insured group and individual plans across Oregon, Alaska, Texas, and Washington.
- Dental Insurance Premiums: Delta Dental of Oregon and Delta Dental of Alaska plans (provided under the Moda Health umbrella) generate premium revenue from group and individual dental plans. Delta Dental plans are available in Premier and PPO network variants.
- Pharmacy Benefit Management: Moda Health provides pharmacy benefit management through the Navitus network, ArrayRx discount program, and mail-order pharmacy services (Costco, Postal Prescription Services), generating revenue through pharmacy-related premiums and administrative fees.
- Third-Party Administration (BenefitHelp Solutions): BenefitHelp Solutions, a Moda Health subsidiary, provides third-party administrative services for self-funded employer plans including FSA, HRA, and commuter benefit administration, generating administrative fee revenue.
- Medicare Plan Premiums: Moda Health offers Medicare Supplement and Medicare Advantage plans, generating premium revenue from Medicare-eligible individuals in Oregon and Alaska.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Individual and Group Medical Plans — Quote-based, tiered by metal level (Platinum/Gold/Silver/Bronze) and network (Connexus, Synergy, Summit, Moda Select, Pioneer) |
| Subscription | Monthly | Individual and Group Dental Plans (Delta Dental) — Quote-based, varying by plan type and network tier |
| Subscription | Monthly | Medicare Supplement Plans — Quote-based, state-specific rate sheets for Oregon and Alaska |
| Subscription | Monthly | Medicare Advantage Plans — Quote-based, with 7 a.m. to 8 p.m. seven-day-a-week member services |
| Other | Pay-as-you-go | ArrayRx Pharmacy Discount Card — Free program offering savings on prescription medications |
| Subscription | Monthly | Short-Term Medical Plans — Quote-based for Oregon and Alaska |
Go-to-market motion4 records
Distribution channels5 records
Marketing channels6 records
Moda Health product offering
Product offeringCore offering
Moda Health is a private health insurance provider selling fully insured and self-funded medical, dental, and pharmacy benefit plans to employer groups, individuals and families, and government programs. It also operates a pharmacy benefit management arm and a third-party administrator subsidiary (BenefitHelp Solutions) that administers self-funded plans and COBRA coverage for other employers.
Product overview
Moda Health is a health insurance provider offering a comprehensive portfolio of medical, dental, and pharmacy benefit plans through multiple delivery channels. The company's core products include medical insurance plans (PPO, HDHP, coordinated care through Synergy/Summit networks), dental plans through Delta Dental partnerships, and pharmacy benefits managed through Navitus Network and ArrayRx. The portfolio includes specialized offerings such as Moda 360 (data-driven personalized healthcare), Medicare Supplement and Medicare Advantage plans, individual and group plans, short-term medical coverage, Association Health Plans for small businesses, Equal Funding arrangements, Oregon Health Plan Medicaid managed care, and employer wellness programs including health coaching, Sprout at Work digital wellness app, and various discount programs (Active&Fit Direct, ChooseHealthy, TruHearing). The company provides digital tools including Member Dashboard, Employer Dashboard, and Provider Finder, along with third-party administration services through its BenefitHelp Solutions subsidiary. Moda Health operates primarily in Oregon and Alaska markets.
Differentiator
Problem solved
Functional benefit
Products and services
- Medical Insurance Plans
Companies that use Moda Health
Customer profileSegments6 records
Ideal customer profiles6 records
Moda Health technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration21 records
Feature9 records
Moda Health partnerships and signals
Strategic signalPartnerships
25 partnerships are on record, tiered core and supporting.
- Delta Dental of Oregon (Oregon Dental Service)coreModa Health provides dental plans in Oregon through Oregon Dental Service, dba Delta Dental Plan of Oregon. Delta Dental provides one of the nation's largest dental networks, with over 155,000 Delta Dental Premier dentists and 110,000 Delta Dental PPO dentists nationwide, and over 2,400 providers in Oregon.
- Delta Dental of AlaskacoreModa Health provides dental plans in Alaska through Delta Dental of Alaska. Delta Dental of Alaska provides access to the Delta Dental Premier and PPO networks with over 440 providers in Alaska.
- BenefitHelp SolutionscoreBenefitHelp Solutions is a Moda Health subsidiary providing third-party administrative services including FSA, HRA, commuter expense reimbursement account administration, online account access, AutoPay, COBRA administration, and premium administration for self-funded employer plans.
- Aetna (Aetna Signature Administrators)coreAetna PPO Network through Aetna Signature Administrators (ASA) provides national in-network coverage for Moda Health members outside of Oregon and Alaska. The ASA network includes over 1.5 million physicians and ancillary providers and more than 6,000 hospitals across all 50 states.
- Navitus Health SolutionscoreNavitus Network provides pharmacy benefit management services including access to over 95% of pharmacies in Oregon and more than 65,000 pharmacies nationwide. Major chain pharmacies in the network include Costco, CVS, Fred Meyer, Safeway/Albertsons, Walgreens, Walmart, and Carrs.
- ArrayRxcoreModa Health administers the ArrayRx Discount Card Program, offering prescription medication savings. Available at ArrayRxCard.com. ArrayRx includes both a Core network and a Broad network for pharmacy access.
- First Choice Health NetworksupportingFirst Choice Health Network provides in-network care access for Moda Health members in Washington state and Alaska, including Alaska Regional Hospital and other contracted providers. Part of the Pioneer Network tier structure in Alaska.
- Private HealthCare Systems (PHCS)supportingPHCS Network provides in-network care access for Moda Health members outside of Oregon or Washington, offering the largest PPO medical network nationwide with thousands of doctors, clinics, and hundreds of hospitals.
- First Health NetworksupportingFirst Health Network provides emergency and urgent care coverage for Moda Health members traveling outside network service areas. Services received through First Health Network are paid at the in-network benefit level.
- Costco Pharmacy (Mail Order)supportingCostco Mail Order pharmacy provides 90-day supply mail-order services for Moda Health members with chronic health conditions requiring ongoing medication (e.g., high blood pressure, asthma, diabetes). Costco is partnered for mail-order pharmacy services alongside Postal Prescription Services.
- Postal Prescription Services (PPS)supportingPostal Prescription Services (PPS) provides mail-order pharmacy services for Moda Health members requiring ongoing treatment for chronic conditions. PPS is partnered alongside Costco for 90-day supply mail-order options.
- Willamette Dental GroupsupportingModa Health's Delta Dental Direct Option plans require members to use Willamette Dental Group providers exclusively. Direct Option plans provide copay-based dental care and are available alongside non-voluntary Delta Dental plans for groups size 5-99.
- Associated Industries of the Inland Northwest (AIIN)supportingAIIN is a membership affiliate partner for Moda Health's Association Health Plans (AHPs) in Oregon and Alaska, enabling small businesses to access affordable health coverage through industry group buying power.
- ALLtechsupportingALLtech is a membership affiliate partner for Moda Health's Association Health Plans (AHPs) in Oregon, specifically serving employers in Oregon's technology sector through the tech industry health trust.
- Advanced Professionals Insurance & Benefit SolutionssupportingAdvanced Professionals Insurance & Benefit Solutions serves as the Administration and Technology partner for Moda Health's Association Health Plans (AHPs), providing administrative infrastructure and technology solutions for the AHP program.
- Associated Industries Management Services (AIMS)supportingAssociated Industries Management Services serves as the Third-Party Administrator for Moda Health's Association Health Plans (AHPs), handling plan administration and compliance.
- OmnitradesupportingOmnitrade provides the Health Trust Platform for Moda Health's Association Health Plans (AHPs), enabling technology infrastructure for plan management and enrollment.
- Assist AmericasupportingAssist America provides emergency medical assistance for Moda Health members traveling more than 100 miles from home, including medical consultations, foreign hospital admission help, and prescription assistance. Available 24/7 at 800-304-4585.
- TruHearingsupportingTruHearing provides discounted hearing aids and routine hearing aid exams for eligible Moda Health members, making hearing aids more affordable through negotiated provider rates.
- IDX IdentitysupportingIDX Identity provides complete identity theft protection for Moda Health individual members at no extra cost, including MIDAS technology to monitor health claims, credit monitoring, dark web monitoring, and Social Security Number tracing.
- CirrusMDsupportingCirrusMD provides 24/7 text-a-doctor telemedicine services for Moda Health members, enabling fast private access to doctors via text, photo, or video chat without appointments. Available at no cost to members.
- Active&Fit DirectsupportingActive&Fit Direct provides Moda Health members with access to 16,000+ fitness centers, 5,500+ digital workout videos, and the ability to switch fitness centers, offering discounted gym memberships as part of member wellness benefits.
- ChooseHealthysupportingChooseHealthy provides Moda Health members with discounts up to 55% on health and fitness brands (Garmin, Vitamix, PRO Compression, Fitbit) and up to 25% off acupuncture, chiropractic, and therapeutic massage services through network providers.
- Microsoft HealthVault (Dental Tools)supportingDental Tools powered by Microsoft HealthVault allow Moda Health members to store dental health information, conduct risk assessments, calculate treatment costs, and share data with caregivers for more coordinated and effective dental care.
- Oregon Health Plan (OHP) / EOCCOsupportingModa Health serves Oregon Health Plan (OHP) members through its EOCCO (Eastern Oregon Coordinated Care Organization) subsidiary, providing Medicaid-funded healthcare coverage for members in eastern Oregon.
Scale indicators5 records
Recent moves6 records
Expansion highlights6 records
Moda Health competitors and assessment
Company assessmentBroad incumbents
- UnitedHealth Group: Largest U.S. health insurer and PBM through UnitedHealthcare and Optum. Operates broadly across Moda's geographies and competes on group, individual, Medicare, and dental; also a benchmark for scale economics that pressure Moda.
- CVS Health (Aetna): National health insurer and PBM owning Aetna — which supplies Moda's national PPO network through Aetna Signature Administrators. Competes broadly in Moda's group and individual markets and sets the bar on integrated payer-PBM-retail care.
Direct peers
- PacificSource Health Plans: Oregon-headquartered, mutual regional health plan offering medical, dental, and Medicare coverage in the Pacific Northwest. Directly competes with Moda in Oregon group and individual markets, although it has announced exit from the Oregon individual market at end of 2026.
- Kaiser Permanente Northwest: Integrated payer-provider serving Oregon and Washington with HMO medical, dental, pharmacy, and wellness under one system. Competes with Moda's Synergy/Summit Medical Home networks as an integrated-care alternative in the Pacific Northwest.
- Delta Dental of California: Largest U.S. dental benefits carrier and parent-affiliated network partner to Moda's Delta Dental of Oregon and Delta Dental of Alaska subsidiaries. Comparable on dental-network leverage and integrated employer dental products.
- BridgeSpan Health: Oregon/Washington individual-market health plan affiliated with Cambia Health Solutions. Competes directly with Moda in Oregon and Washington individual and small-group segments with comparable ACA-compliant metal-tier products.
- Premera Blue Cross: Washington-based regional Blue plan serving Washington and Alaska with medical, dental, and Medicare products. Closest comparable to Moda in scale, multi-state footprint, and integrated medical/dental offering across the Pacific Northwest.
- Regence BlueCross BlueShield: Blue Cross Blue Shield plan operating in Oregon, Washington, Idaho, and Utah with medical, dental, and Medicare products. Closely comparable to Moda on multi-state Pacific Northwest footprint, product breadth, and employer-group focus.
- Providence Health Plan: Oregon-based health plan affiliated with Providence Health & Services, offering group, individual, and Medicare products in Oregon. Direct competitor in Oregon group and individual markets; exiting Oregon individual market at end of 2026.
Emerging players
- ATRIO Health Plans: Oregon-based Medicare Advantage HMO plan serving multiple Oregon counties. Comparable to Moda's Medicare Advantage line within overlapping Oregon service areas.
Market position
Strengths5 records
Weaknesses4 records
Competitive moat6 records
Key risks5 records
Key highlights7 records
Customer concentration
Moda Health social profiles
Digital presenceModa Health financial estimates
Financial estimateRevenue estimate
Valuation estimate
Moda Health leadership team
Management profileNumber of profiles
Profiles9 records
Moda Health subsidiaries and ownership
Company hierarchySubsidiaries3 records
Moda Health funding detail
Funding detailFunding overview
Funding rounds2 records
Investors1 record
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Moda Health M&A and investment
M&A and investmentM&A
Investments2 records
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Moda Health
What does Moda Health do?
Moda Health is a private health insurance provider selling fully insured and self-funded medical, dental, and pharmacy benefit plans to employer groups, individuals and families, and government programs. It also operates a pharmacy benefit management arm and a third-party administrator subsidiary (BenefitHelp Solutions) that administers self-funded plans and COBRA coverage for other employers.
Is Moda Health a public or private company?
Moda Health is a private company. It is classified as venture growth investor backed and is currently operating.
When was Moda Health founded?
Moda Health was founded in 1955. It employs 1,001 to 5,000 people.
Where is Moda Health based?
Moda Health is headquartered in Portland, United States, in the North America region.
How does Moda Health make money?
Five revenue lines are on record. Medical Insurance Premiums are the primary driver. The others are dental Insurance Premiums, pharmacy Benefit Management, third-Party Administration (BenefitHelp Solutions) and medicare Plan Premiums.
Who are Moda Health's main competitors?
Broad incumbents on record are UnitedHealth Group and CVS Health (Aetna). Direct peers are PacificSource Health Plans, Kaiser Permanente Northwest, Delta Dental of California, BridgeSpan Health, Premera Blue Cross, Regence BlueCross BlueShield and Providence Health Plan. ATRIO Health Plans is listed as an emerging player.
Does Moda Health have an API?
No public API is recorded for Moda Health.