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ATRIO Choice Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ATRIO Choice Rx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ATRIO Choice Rx (PPO) in 2026, please refer to our full plan details page.
ATRIO Choice Rx (PPO) is a PPO 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 2026.
It's important to know that ATRIO Choice Rx (PPO) 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 Choice Rx (PPO).
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 Choice Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $300.00 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 combined Maximum Out-Of-Pocket cost of $9500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Choice Rx (PPO) Medicare plan features an annual drug deductible of $300. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. For Tier 2 generic medications, standard pharmacy costs are just a $10 copay for a 1-month supply and a $20 copay for a 3-month supply. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply and a $94 copay for a 3-month supply at standard pharmacies and through standard mail order. Tier 4 non-preferred drugs cost a $100 copay for a 1-month supply and a $200 copay for a 3-month supply. Specialty medications in Tier 5 require a 28% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers comprehensive medical coverage with no copay for primary care physician visits and annual physical exams. Specialist visits, physical therapy, and routine hearing and vision exams require a $40 to $45 copay with no coinsurance. For hospital care, there is no coinsurance, but patients will pay a daily copay of $350 for the first seven days of acute inpatient stays and a $500 copay for outpatient hospital services. Additional perks include preventive and comprehensive dental services with no copay up to a $200 limit every six months, alongside a $150 annual allowance for eyewear. Members also benefit from up to 24 free one-way transportation trips per year to approved locations and a $25 quarterly allowance for over-the-counter items. Emergency care is accessible with a $130 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Inpatient hospital services are covered under the ATRIO Choice Rx (PPO) with no coinsurance, though prior authorization is required. For acute care, there is a $350 daily copay for days 1-7 and no copay thereafter, while psychiatric care requires a $450 daily copay for days 1-5 and no copay for days 6-90; non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
ATRIO Choice Rx (PPO) outpatient services feature a $500 copay and no coinsurance for outpatient hospital and observation services, and a $225 copay with no coinsurance for ambulatory surgical center services. Outpatient blood services are covered with no copay or coinsurance, while some outpatient substance abuse services are covered with no copay or coinsurance, though individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization services are covered by ATRIO Choice Rx (PPO) with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
ATRIO Choice Rx (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
ATRIO Choice Rx (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $250,000 maximum benefit with no coinsurance, requiring a $140 copay for emergency care and a $500 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
ATRIO Choice Rx (PPO) covers primary care physician visits with no copay and specialist, mental health, and physical therapy visits with a $40 copay, all with no coinsurance. Chiropractic benefits are partially covered with a $15 copay and no coinsurance for routine care (other chiropractic services are not covered), while occupational therapy requires a $30 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, screenings, alternative therapies, and memory fitness. Supplemental preventive benefits such as health education, weight management, nutritional/dietary benefits, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by ATRIO Choice Rx (PPO), which offers routine hearing exams and evaluations for a $45 copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance up to a $999 annual maximum per ear, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by ATRIO Choice Rx (PPO), featuring one routine eye exam per year for a $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 annual limit for contact lenses or complete eyeglasses, although individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are covered by ATRIO Choice Rx (PPO), with Medicare-covered dental services requiring a $45 copay and no coinsurance. Other preventive and comprehensive dental services have no copay and no coinsurance, subject to a combined in- and out-of-network maximum benefit of $200 every six months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a coinsurance ranging from no coinsurance up to 20%, with insulin also carrying a $35 copay that does not count toward the plan deductible.
Dialysis Services See details
Dialysis Services are covered under the ATRIO Choice Rx (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
ATRIO Choice Rx (PPO) covers medical equipment with no copay, including Durable Medical Equipment (DME) and prosthetics which require a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
ATRIO Choice Rx (PPO) diagnostic services are partially covered, as lab services are not covered, with covered diagnostic tests requiring no coinsurance and a copay ranging from no copay to $350. Covered radiological services require prior authorization and include diagnostic radiology with a copay and no coinsurance, therapeutic radiology with a 20% coinsurance and no copay, and outpatient X-rays with a $30 copay and coinsurance.
Home Health Services See details
Home Health Services are covered under the ATRIO Choice Rx (PPO) plan 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 Choice Rx (PPO) plan. Although the plan technically features no coinsurance and requires prior authorization, none of the individual cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) sub-services are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by ATRIO Choice Rx (PPO) with no coinsurance, requiring a daily copay of $10 for days 1 to 20 and $214 for days 21 to 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
ATRIO Choice Rx (PPO) covers other services with no copay and no coinsurance, including unlimited acupuncture, an annual wellness visit, and a limited meal benefit after hospitalization or for chronic illness. Over-the-counter (OTC) items are also covered up to $25 every three months, though nicotine replacement therapy and naloxone are not covered.
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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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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