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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 Douglas 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 $590.00 deductible for prescription drugs. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), you will pay $26.20. Once your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The ATRIO Special Needs Plan (HMO D-SNP) offers a range of benefits with varying cost-sharing. Inpatient hospital stays have coinsurance, while outpatient services, including primary care, preventive services, and many other services, typically have a 20% coinsurance. Emergency services have a $110 copay. Additional benefits include coverage for hearing and vision services, with coinsurance for exams and maximum benefit for eyewear. Dental services are covered with coinsurance, along with home health, and some medical equipment. The plan also offers benefits like acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay 7% coinsurance for days 1-6, 8% for days 7-10, and 20% for days 11-90, and no copay; additional days, non-Medicare-covered stays, and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay 14% coinsurance and no copay; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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). Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the ATRIO Special Needs Plan (HMO D-SNP). Emergency Services have a $110 copay, and Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Services 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, all with a 20% coinsurance. Routine chiropractic care is covered with a $300 maximum plan benefit coverage amount every six months, and routine foot care is covered with a $500 maximum plan benefit coverage amount every year.
Preventive Services See details
Preventive Services are covered, with some services not covered including annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, 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, home and bathroom safety devices and modifications, and counseling services. Additional preventive services may have a copay. Kidney disease education services have a 20% coinsurance, while personal emergency response systems have no copay. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit.
Hearing Services See details
Hearing services are partially covered under the ATRIO Special Needs Plan (HMO D-SNP), with a coinsurance of at most 20% for routine hearing exams, and no deductible. Prescription hearing aids, OTC hearing aids, and fitting/evaluation for hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, as well as coverage for eyewear. Eyewear has a combined maximum benefit of $250.00 every two years, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $400 per year. Other services like 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 and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered. Orthodontic services are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is 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 is covered, with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, and a 15% coinsurance for Medical Supplies. 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, including 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%, with a minimum coinsurance of 20%, and there is no copay.
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, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover 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. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. For days 1-20, there is no coinsurance, and for days 21-100, there is a 10% coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The ATRIO Special Needs Plan (HMO D-SNP) covers acupuncture with a maximum benefit of $300 every six months. This plan also covers over-the-counter items up to $75 every three months, and offers a meal benefit with no maximum coverage amount, requiring prior authorization. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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