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ATRIO Special Needs Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ATRIO Special Needs Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ATRIO Special Needs Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
ATRIO Special Needs Plan (HMO D-SNP) is a HMO D-SNP plan offered by ATRIO Health Plans available for enrollment in 2025 to people living in Klamath County. This plan received an overall rating of 2 out of 5 stars in 2026.
It's important to know that ATRIO Special Needs Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
ATRIO Special Needs Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about ATRIO Special Needs Plan (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For ATRIO Special Needs Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The ATRIO Special Needs Plan (HMO D-SNP) features an annual prescription drug deductible of $615. This deductible must be met before the plan begins to cover the cost of your prescription medications. Specific drug tier coverage details, including copayments and coinsurance rates for individual tiers, are currently unavailable for this plan. To understand your exact out-of-pocket costs for specific medications under this HMO D-SNP, it is recommended to review the plan's comprehensive formulary.
Additional Benefits
The ATRIO Special Needs Plan (HMO D-SNP) offers comprehensive medical coverage featuring no copays for primary, specialist, inpatient, and outpatient hospital services, though a 20% coinsurance typically applies to outpatient and doctor visits. Emergency services require a $90 copay, which is waived if you are admitted, while urgent care incurs a 20% coinsurance with no copay. For inpatient stays, you will pay no copay, but coinsurance rates apply depending on the length of your stay. This plan also provides valuable supplemental benefits, including routine dental and vision care with no copays and generous maximum allowances, alongside no-copay hearing exams. Members can take advantage of up to 24 free one-way transportation trips per year and a $155 quarterly over-the-counter item allowance with no copays or coinsurance. Additionally, home health care and select diabetic equipment are fully covered with no copays or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by the ATRIO Special Needs Plan (HMO D-SNP) with prior authorization required, offering no copays for acute or psychiatric stays. Acute stays incur a coinsurance of 7% for days 1-6, 8% for days 7-10, and 20% for days 11-90, while psychiatric stays require a 14% coinsurance, with additional days, upgrades, and non-Medicare-covered stays not covered.
Outpatient Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers outpatient services with no copay, subject to a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
The ATRIO Special Needs Plan (HMO D-SNP) covers partial hospitalization services, with costs ranging from no copay and a 20% coinsurance to a $55 copay and no coinsurance.
Ambulance and Transportation Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
ATRIO Special Needs Plan (HMO D-SNP) primary care, specialist, and therapy benefits feature no copays and a 20% coinsurance, while telehealth services are available with no copay and no coinsurance. Chiropractic services are partially covered, offering unlimited routine care with no copays and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay and no coinsurance for most services, except for Kidney Disease Education which has a 20% coinsurance and no copay. While select benefits like alternative therapies and memory fitness are included, several services such as annual physical exams, health education, in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
ATRIO Special Needs Plan (HMO D-SNP) offers partially covered hearing exams with no copay, no coinsurance, and no deductible, though routine exams and fitting evaluations are not covered. Some prescription hearing aid services are covered, but OTC hearing aids and all prescription hearing aid types—including inner, outer, and over the ear—are not covered in practice.
Vision Services See details
Vision services are covered by ATRIO Special Needs Plan (HMO D-SNP), featuring one routine eye exam per year with no copay and a 20% coinsurance, with no deductible, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay, no coinsurance, and no deductible, up to a $250 combined maximum benefit every two years.
Dental Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers Medicare dental services with no copay and a 20% coinsurance. Other dental services, including preventive, diagnostic, restorative, and orthodontic care, are covered with no copay and no coinsurance up to a maximum benefit limit of $250 every six months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
ATRIO Special Needs Plan (HMO D-SNP) covers durable medical equipment and prosthetics or medical supplies with no copay and 20% coinsurance, though prior authorization is required. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay, but they require prior authorization and a 20% coinsurance. This benefit covers diagnostic procedures, lab services, therapeutic and diagnostic radiological services, as well as outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay and prior authorization required, though only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
ATRIO Special Needs Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no copay, requiring prior authorization but no prior three-day inpatient hospital stay. There is no coinsurance for days 1 through 20, followed by a 10% coinsurance for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by the ATRIO Special Needs Plan (HMO D-SNP) include acupuncture, annual wellness exams, a limited meal benefit, and over-the-counter (OTC) items, all with no copay and no coinsurance. The OTC benefit provides up to $155 every three months, though nicotine replacement therapy and naloxone are not covered.
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