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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 2025, 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 2.5 out of 5 stars in 2025.
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 $26.20. 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 $590.00 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 $9350.00 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) has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. If you qualify for the low-income subsidy, the plan's premium is $26.20. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The ATRIO Special Needs Plan (HMO D-SNP) offers a wide range of benefits, including inpatient hospital care with varying coinsurance rates, outpatient services with 20% coinsurance, and no copay for home health services. This plan also includes coverage for emergency services with a $90 copay, primary care services with 20% coinsurance, and preventive services with no copay for Medicare-covered services, and a variety of vision and dental services with varying coinsurance and maximum benefit amounts. Additionally, the plan covers home infusion bundled services, dialysis services, and medical equipment, all with coinsurance requirements. The plan provides coverage for ambulance and transportation services with 20% coinsurance, and covers a number of services with no copay, including diagnostic and radiological services. However, some services such as cardiac rehabilitation and certain home-based services are not covered. The plan offers additional benefits like acupuncture, over-the-counter items, and a meal benefit, each with specific limits and requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with no copay. For acute care, you will pay 7% coinsurance for days 1-6, 8% for days 7-10, and 20% for days 11-90, and for psychiatric care, you will pay 14% coinsurance. Additional days and non-Medicare covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a minimum and maximum coinsurance of 20%. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the ATRIO Special Needs Plan (HMO D-SNP), with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the ATRIO Special Needs Plan (HMO D-SNP), including both ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with various modes of transportation available.
Emergency Services See details
Emergency Services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with a $90 copay and no coinsurance. Urgently Needed Services are covered with a 20% coinsurance and no copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The ATRIO Special Needs Plan (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance, while occupational therapy, mental health, psychiatric services, and opioid treatment program services have a 20% coinsurance. Chiropractic and podiatry services also have a 20% coinsurance, with a maximum plan benefit coverage amount of $300 and $500 respectively.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and other preventive services that require prior authorization. Other covered services include Personal Emergency Response System (PERS), Alternative Therapies, Nutritional/Dietary Benefit, Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are partially covered by the ATRIO Special Needs Plan (HMO D-SNP), with routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) not covered. Hearing exams have a coinsurance of at most 20% with no deductible.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and eyewear with a combined maximum of $250 every two years. Routine eye exams are covered once per year.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum benefit of $250 every six months, and also cover oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs. For Medicare Part B Insulin Drugs, you will pay a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the ATRIO Special Needs Plan (HMO D-SNP), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the ATRIO Special Needs Plan (HMO D-SNP), with no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
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 authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the ATRIO Special Needs Plan (HMO D-SNP). This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services require prior authorization and are covered. For days 1-20, there is no coinsurance, and for days 21-100, there is a 10% coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for acupuncture, over-the-counter (OTC) items, a meal benefit, and an annual wellness exam. Acupuncture is covered with a maximum benefit of $300 every six months, and OTC items have a $150 maximum benefit every three months. The meal benefit requires prior authorization. Some services are not covered, including: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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