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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 2025, 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 3 out of 5 stars in 2025.
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 $35.00. 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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6500.00 (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 $6500.00 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy, such as an $8.00 copay for preferred generic drugs at a standard pharmacy. For specialty tier drugs, there is no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with copays, and ambulance services with a $350 copay. The plan covers various services like primary care, preventive services, and vision services. Dental services are also covered, with a $200 maximum plan benefit. Additional benefits include hearing exams, home infusion, dialysis, and medical equipment coverage with varying copays and coinsurance. Other services like acupuncture, over-the-counter items, and a meal benefit are also available. However, it's important to note that certain services like cardiac rehabilitation, podiatry, and some home health services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $290 copay for days 1-8 and no copay for days 9-90, and for Inpatient Hospital Psychiatric, you will pay a $450 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a $500 copay, observation services with a $500 copay, and ambulatory surgical center (ASC) services with a $225 copay. Outpatient substance abuse services are not covered, but outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the ATRIO Choice Rx (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by the ATRIO Choice Rx (PPO) plan. Ground and air ambulance services have a copay of $350, and no coinsurance. Transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the ATRIO Choice Rx (PPO) plan, with a $120 copay and no coinsurance; Urgently Needed Services have a $55 copay and no coinsurance; Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The ATRIO Choice Rx (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$40 copay, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Alternative therapies and fitness benefits are covered, with a maximum plan benefit of $300 every six months and $175 every six months, respectively.
Hearing Services See details
The ATRIO Choice Rx (PPO) plan covers hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a maximum benefit of $999 per year and a copay between $699 and $999. OTC hearing aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $45 copay, and eyewear with a combined maximum of $150 per year, covering contact lenses and eyeglasses (lenses and frames) with a limit of one pair per year. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered. Medicare Dental Services have a $45 copay. Other Dental Services include 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, all of which are covered. There is a $200 maximum plan benefit coverage amount for these services, which applies to both in-network and out-of-network services, and resets every six months.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0% and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the ATRIO Choice Rx (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, is covered under the ATRIO Choice Rx (PPO) plan, with a 20% coinsurance for DME, Prosthetic Devices and Medical Supplies. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
For ATRIO Choice Rx (PPO), Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have a $20 copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance up to 20%, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the ATRIO Choice Rx (PPO) plan with no copay or 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 Choice Rx (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ATRIO Choice Rx (PPO) plan. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
The ATRIO Choice Rx (PPO) plan covers acupuncture with a maximum benefit of $300 every six months, and also covers over-the-counter items with a maximum benefit of $25 every three months, but the plan does not cover other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services. The plan also offers a meal benefit that requires prior authorization.
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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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