Reputation grade
F
Peer-relative, A–F
Insurer profile · NAIC + CMS
Moda Health Plan, Inc.
Moda Health Plan, Inc.'s complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- F
- Reputation grade
- 21.3%
- Claims denied
- 3
- States (CMS data)
The verdict
Moda Health Plan, Inc. earns a F reputation grade - a significantly worse record than peers, according to CMS Transparency in Coverage filings, 21.3% of its marketplace claims were denied across 3 states.
- F
- reputation grade
- 21.3%
- claims denied (CMS)
NAIC complaint index
N/A
1.0 = market average; lower is better
Claim denial rate
21.3%
CMS, 3 states
Graded on 1 of 3 measures: claim denials. The score is rescaled across the measures available, so it is not directly comparable with a carrier graded on more of them.
How we calculated this grade →Moda Health Plan, Inc. - claim denial rate by state
- AK
AK: 47.0% denied (95,902 of 204,058 claims)
47 % of claims denied
- TX
TX: 28.3% denied (42,672 of 150,551 claims)
28 % of claims denied
- OR 16
OR: 15.7% denied (176,356 of 1,123,420 claims)
16 % of claims denied
What this shows Denial rates vary by state plan and network. Across 3 reporting states, Moda Health Plan, Inc. denied 21.3% of marketplace claims on average.
Among states with enough reported claims to compare, Moda Health Plan, Inc.'s highest marketplace denial rates in this dataset are in Alaska (47.0%), Texas (28.3%), and Oregon (15.7%). State-level rates reflect the specific plans Moda Health Plan, Inc. offers there and how each state's regulators and utilization-review rules apply, not necessarily the carrier's national practice.
CMS marketplace filing
Reported appeal outcomes for Moda Health Plan, Inc.
247
appeals filed
98
overturned (reported outcomes)
39.7%
of appeals with a reported outcome
The largest state samples are Oregon (173 filed, 67 overturned), Texas (39 filed, 14 overturned), and Alaska (35 filed, 17 overturned); 3 states contribute to the profile total.
CMS reports an overturn outcome for 247 of these 247 filed appeals; missing outcomes are excluded from the percentage. These filing totals are not a prediction for an individual appeal. View the CMS source ↗
What the data shows for Moda Health Plan, Inc.
Moda Health Plan, Inc. carries a F reputation grade in PlainInsurer's dataset, with a composite score of 14.6 (higher means more consumer friction relative to size). It does not yet carry enough NAIC complaint history for a normalized complaint index.
On the claims side, CMS Transparency-in-Coverage filings show Moda Health Plan, Inc. denied 21.3% of marketplace claims across 3 reporting states - an elevated rate that warrants checking the plan's appeal-success record before enrolling.
See where Moda Health Plan, Inc. sits against every reporting carrier in the claim-denial rate ranking.
Source: NAIC Consumer Information Source complaint data (2024). Source: CMS Transparency in Coverage PUF (PY2026), cms.gov.
Aggregates only, not advice. Full terms on the disclaimer.
Other F-graded carriers in PlainInsurer's dataset include Kemper Auto and Root Insurance, and the closest overall composite score to Moda Health Plan, Inc.'s 14.6 belongs to CareSource West Virginia Co. (14.1), each rescaled across the measures that carrier reports.
Other F-graded insurers
Carriers with the same peer-relative reputation grade
| Insurer | Grade |
|---|---|
| Kemper Auto | F |
| Root Insurance | F |
| Dairyland Insurance (Sentry) | F |
| Hippo Insurance | F |
| Esurance (Allstate) | F |
Closest composite score to Moda Health Plan, Inc.
Carriers with the nearest overall composite score (14.6)
| Insurer | Composite score |
|---|---|
| CareSource West Virginia Co. | 14.1 |
| AmeriHealth Caritas VIP Next, Inc. | 15.1 |
| Tower Hill Insurance | 15.2 |
| AmeriHealth Caritas Florida, Inc. | 13.5 |
| Oscar Insurance Company | 16.2 |
Questions about Moda Health Plan, Inc.
What does Moda Health Plan, Inc.'s grade mean?
Moda Health Plan, Inc. received a grade of F, indicating a significantly worse record than peers.
How many complaints does Moda Health Plan, Inc. have?
NAIC's public bulk data does not include a complaint-volume estimate for Moda Health Plan, Inc. - the carrier may be new, small, or file under a parent company. Absence of an estimate is missing data, not evidence of zero complaints.
How do I file a complaint against Moda Health Plan, Inc.?
File against Moda Health Plan, Inc. through your state's Department of Insurance or the NAIC consumer portal at naic.org.
Is Moda Health Plan, Inc. a good insurance company?
PlainInsurer's F grade for Moda Health Plan, Inc. reflects a significantly worse record than peers relative to peers on published complaint and denial data.
What types of insurance does Moda Health Plan, Inc. offer?
Detailed line-of-business data isn't currently available for Moda Health Plan, Inc.. The carrier is licensed in 0 states.
Source: NAIC published complaint index + CMS Transparency in Coverage PY2026 Complaint index, reputation grade and per-state claim denial rates for Moda Health Plan, Inc. · 2024
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The full PlainInsurer extract, covering every insurer including Moda Health Plan, Inc., is available as CSV and JSON. Underlying federal data is public domain; see our methodology for the compilation and grading method.
Data: NAIC published complaint index (2024) · CMS Transparency in Coverage PUF PY2026. Not affiliated with NAIC or CMS.
Every figure on PlainInsurer comes directly from NAIC MCAS and CMS Transparency in Coverage data; no editor types in numbers. See our editorial standards or methodology, or report an error. Data current as of 2026-08-11. Grades measure only the published complaint/denial data; we don't recommend any insurer or policy.