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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 Douglas 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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $20.00. 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 a $100.00 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 $6200.00 (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 $6200.00 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 $100 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, you will pay an $8 copay for a preferred generic drug at a standard pharmacy, or a $47 copay for a standard generic drug at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your prescriptions.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers coverage for a wide range of services. Inpatient hospital stays have a $450 copay for the first five days, and then no copay for the rest of the stay. Outpatient services, emergency services, and primary care all have varying copays depending on the specific service. The plan also includes benefits for vision, dental, and hearing services. Vision services include eye exams for a $45 copay, and eyewear up to $200 per year. Dental services include a $45 copay for Medicare-covered services, and other dental services up to a $300 maximum benefit every three months. Hearing services include hearing exams for a $45 copay, and coverage for prescription hearing aids with a copay between $699 and $999.
Inpatient Hospital See details
Inpatient Hospital coverage, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, is covered with 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, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $400 copay, ambulatory surgical center services have a $225 copay, and individual/group sessions for outpatient substance abuse have a $45 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the ATRIO Choice Rx (PPO) plan. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the ATRIO Choice Rx (PPO) plan, including ground and air ambulance services, each with a $300 copay. The plan also covers transportation services to a plan-approved health-related location for up to 24 one-way trips per year, utilizing rideshare services, bus/subway, medical transport, and other methods, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services with the ATRIO Choice Rx (PPO) plan include a $140 copay, while Urgently Needed Services have a $60 copay, and there is no coinsurance for either service. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, 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 $40 copay, and physician specialist services with a $45 copay. It also covers mental health specialty services, individual and group sessions with a $40 copay, psychiatric services with individual and group sessions with a $45 copay, and physical therapy and speech-language pathology services with a $40 copay. Additional telehealth benefits are covered with a copay between $0 and $45, and opioid treatment program services are covered with a $45 copay. Podiatry services are not covered.
Preventive Services See details
The ATRIO Choice Rx (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Some services, such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services for ATRIO Choice Rx (PPO) include hearing exams with a $45 copay, and coverage for fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $699 and $999 for all types of hearing aids, but not for inner ear, outer ear, or over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $45 copay, and eyewear with a combined maximum plan benefit of $200 every year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are also covered.
Dental Services See details
The ATRIO Choice Rx (PPO) plan covers dental services, including Medicare dental services with a $45 copay, and other dental services up to a $300 maximum benefit every three months. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services, and prosthodontics, fixed are covered, but adjunctive general services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the ATRIO Choice Rx (PPO) plan. Prior authorization is required for this benefit, and you may have a coinsurance between 0% and 20% depending on the drug.
Dialysis Services See details
Dialysis Services are covered under the ATRIO Choice Rx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the ATRIO Choice Rx (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and a prior authorization is required, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services with ATRIO Choice Rx (PPO) includes coverage for diagnostic procedures and tests with a copay between $0 and $45, while lab services are not covered. Radiological Services are covered, including diagnostic radiological services with a maximum copay of $150, therapeutic radiological services with a $60 copay, and outpatient X-ray services with a $15 copay.
Home Health Services See details
Home Health Services are covered by the ATRIO Choice Rx (PPO) 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 Choice Rx (PPO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ATRIO Choice Rx (PPO) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $200. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The ATRIO Choice Rx (PPO) plan covers acupuncture with a maximum plan benefit coverage amount of $100 every six months, over-the-counter items up to $50 every three months, and meal benefits with prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others 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.
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