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ATRIO Select Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ATRIO Select Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ATRIO Select Rx (HMO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
ATRIO Select Rx (HMO) is a HMO plan offered by ATRIO Health Plans available for the 2025 plan year 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 Select Rx (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about ATRIO Select Rx (HMO).
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 Select Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $15.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: information not available.
This plan has a $350.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 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 Select Rx (HMO) plan has a $350 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $20 copay for preferred generic drugs at a standard pharmacy, while non-preferred drugs have a 27% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The ATRIO Select Rx (HMO) plan offers a range of benefits with varying cost-sharing. You'll have no copay for primary care, preventive services, and home health services. Many services have copays, such as inpatient hospital stays ($350), outpatient services ($300-$350), and emergency services ($120). The plan also provides coverage for vision, hearing, and dental services. Hearing aids have a copay between $699 and $999. Dental services include a $40 copay for Medicare dental, and other dental services have a maximum benefit of $200 every six months. Additional benefits include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization. For Acute, the copay is $350 for days 1-6 and no copay for days 7-90, while for Psychiatric, the copay is also $350 for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services, each with a copay of $350 and $300, respectively. Outpatient substance abuse services are not covered, while outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the ATRIO Select Rx (HMO) plan with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by ATRIO Select Rx (HMO), with a $350 copay for both ground and air ambulance services. The plan also covers transportation services to a plan-approved health-related location, with up to 12 one-way trips per year using rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the ATRIO Select Rx (HMO) plan, with a $120 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $120 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The ATRIO Select Rx (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay. Occupational therapy services have a $35 copay. Physician specialist services have a $40 copay. Mental health specialty services, psychiatric services, and opioid treatment program services all have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay ranging from $0 to $40.
Preventive Services See details
The ATRIO Select Rx (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services such as alternative therapies and fitness benefits are covered, with a maximum plan benefit coverage amount of $300.00 for alternative therapies, and $300.00 for fitness benefits. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, nutritional/dietary benefits, 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 are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids are covered. Routine hearing exams are limited to one visit per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids are covered with a copay between $699 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The ATRIO Select Rx (HMO) plan covers vision services, including routine eye exams with 1 visit per year, and eyewear such as eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. This plan covers contact lenses with 1 pair per year, and a maximum plan benefit coverage amount of $100.00 per year. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have a maximum plan benefit coverage amount of $150.00 per year each.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, and other dental services with a maximum benefit of $200 every six months. 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 all covered. Orthodontic services are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the ATRIO Select Rx (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, and medical supplies, are covered. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices have a 20% coinsurance with no copay, but Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $20 and $50, while Lab Services and Outpatient X-Ray Services have a $20 copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20%, and the minimum coinsurance is 0% for Diagnostic Radiological Services, and 20% for Therapeutic Radiological Services.
Home Health Services See details
Home Health Services are covered by the ATRIO Select Rx (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the ATRIO Select Rx (HMO) plan. 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 are covered under the ATRIO Select Rx (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The ATRIO Select Rx (HMO) plan covers acupuncture with a maximum benefit of $300 every six months, over-the-counter items with a maximum benefit of $30 every three months, and a meal benefit that requires prior authorization. The plan also covers an annual wellness exam and offers nicotine replacement therapy as a Part C OTC benefit. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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