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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 Douglas 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) has an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before your plan benefits begin to pay. Specific drug coverage tier details, including individual copayments and coinsurance rates, are not available for this plan. To determine your exact prescription costs under this Medicare D-SNP, you should consult the plan's formulary or contact the provider directly.
Additional Benefits
The ATRIO Special Needs Plan (HMO D-SNP) offers comprehensive medical coverage featuring no copays for inpatient hospital stays, outpatient services, and primary care visits, though coinsurance rates typically range from 7% to 20%. Emergency room visits require a $110 copay, which is waived upon hospital admission, while telehealth and home health services are fully covered with no copay and no coinsurance. Skilled nursing facility care is also available with no copay, requiring no coinsurance for the first 20 days of your stay. This plan also includes key supplemental benefits such as 24 one-way transportation trips per year and up to $400 annually for dental care with no copay and no coinsurance. Additionally, members can access a $250 eyewear benefit every two years, diagnostic hearing exams with no cost-sharing, and an $85 allowance for over-the-counter items every three months.
Inpatient Hospital See details
ATRIO Special Needs Plan (HMO D-SNP) partially covers inpatient hospital services, which require prior authorization and have no copays. For acute inpatient stays, there is a coinsurance of 7% for days 1 through 6, 8% for days 7 through 10, and 20% for days 11 through 90, while psychiatric stays carry a 14% coinsurance; however, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copays, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services, and the deductible is waived for your first three pints of blood.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the ATRIO Special Needs Plan (HMO D-SNP) with cost-sharing that consists of either a $55.00 copay with no coinsurance or no copay with a 20% 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, subject to prior authorization. The plan also covers up to 24 one-way transportation trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
ATRIO Special Needs Plan (HMO D-SNP) emergency services are covered with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and a 20% coinsurance up to $40, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
ATRIO Special Needs Plan (HMO D-SNP) covers primary care, specialist visits, therapies, mental health, and opioid treatment with no copay and 20% coinsurance, while telehealth services feature no copay and no coinsurance. Routine chiropractic and podiatry services are also covered with no copay 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), offering no copay and no coinsurance for Medicare-covered zero-dollar services, diabetes self-management training, and select supplemental benefits like alternative therapies and memory fitness. Kidney disease education is covered with no copay and a 20% coinsurance, while several other options like annual physical exams, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by the ATRIO Special Needs Plan (HMO D-SNP), which features diagnostic hearing exams with no copay, no deductible, and no coinsurance. Routine hearing exams, hearing aid fittings and evaluations, over-the-counter hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers vision services with no deductibles, offering one routine eye exam per year with no copay and a 20% coinsurance, though other eye exam services are not covered. Eyewear, including glasses and contacts, is covered with no copay and no coinsurance up to a $250 combined maximum benefit every two years.
Dental Services See details
Dental services are covered by the ATRIO Special Needs Plan (HMO D-SNP), which offers Medicare-covered dental care with no copay and 20% coinsurance. Other preventive and comprehensive dental services, including cleanings, exams, and restorative care, are covered with no copay and no coinsurance up to an annual maximum benefit of $400.
Home Infusion bundled Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay, requiring a 20% coinsurance for durable medical equipment and prosthetics, and a 15% coinsurance for medical supplies. While some diabetic equipment services are covered with no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
ATRIO Special Needs Plan (HMO D-SNP) covers diagnostic and radiological services, including lab work, therapeutic radiology, and X-rays, with prior authorization. Members will pay no copay and a 20% coinsurance for these covered services.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the ATRIO Special Needs Plan (HMO D-SNP), as all rehabilitation sub-services require a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by the ATRIO Special Needs Plan (HMO D-SNP) with no copay, requiring prior authorization but allowing admission without a prior three-day 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 Medicare limit are not covered.
Other Services See details
Other services under the ATRIO Special Needs Plan (HMO D-SNP) are partially covered with no copay and no coinsurance, including unlimited acupuncture, an annual wellness exam, and a meal benefit with prior authorization. Over-the-counter items are covered up to $85 every three months, though nicotine replacement therapy, naloxone, and highly integrated services for dual-eligible SNPs are not covered.
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