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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 Douglas 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 $0.00. 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 $5000.00 (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 $5000.00 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 a $300 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs at standard pharmacies and through standard mail order. Tier 2 generic medications cost a $10 copay for a 1-month supply or a $20 copay for a 3-month supply. For brand-name and specialty medications, costs are structured by tier during the initial coverage phase. Tier 3 preferred brands require a $47 copay for a 1-month supply, while Tier 4 non-preferred drugs carry a $100 copay. Tier 5 specialty drugs require a 29% 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 doctor visits, routine physicals, and home health services, while specialist visits require a $40 copay. For hospital care, inpatient stays require a $450 daily copay for the first five days followed by no copay, and outpatient hospital visits carry a $400 copay. In addition to medical care, the plan provides valuable extra benefits including a $50 quarterly over-the-counter allowance and up to 24 one-way transportation trips per year with no copay. Members also receive dental and vision benefits with no copay, including a $300 quarterly dental allowance and a $200 annual limit for eyewear.
Inpatient Hospital See details
Inpatient hospital services are covered by ATRIO Choice Rx (PPO) with no coinsurance and a copay of $450 per day for days 1 through 5, followed by no copay for days 6 through 90. This benefit is partially covered as unlimited additional days are only covered for acute stays, while psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
ATRIO Choice Rx (PPO) covers outpatient services with no coinsurance, featuring a $400 copay per stay for outpatient hospital and observation services, and a $225 copay for ambulatory surgical center services, both requiring prior authorization. Outpatient substance abuse sessions have a $45 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
ATRIO Choice Rx (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by ATRIO Choice Rx (PPO), with ground and air ambulance services requiring a $300 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, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by ATRIO Choice Rx (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care has a $45 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $250,000 lifetime maximum with a $200 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under the ATRIO Choice Rx (PPO) plan feature primary care physician visits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, speech-language, mental health, psychiatric, and opioid treatment services are covered with copays ranging from $40 to $45 and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance for routine care, though other chiropractic services and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are partially covered, excluding services such as health education, in-home safety assessments, personal emergency response systems, weight management, therapeutic massage, and counseling.
Hearing Services See details
ATRIO Choice Rx (PPO) offers partially covered hearing services with no deductible, featuring a $45 copay and no coinsurance for routine hearing exams and fitting evaluations. Prescription hearing aids are also partially covered with copays ranging from $699 to $999 and no coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by ATRIO Choice Rx (PPO), offering one annual routine eye exam with a $45 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 yearly limit for contact lenses or eyeglasses, though separate eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are partially covered by ATRIO Choice Rx (PPO), excluding adjunctive general services, oral and maxillofacial surgery, and orthodontics. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a maximum benefit of $300 every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by ATRIO Choice Rx (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
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 durable medical equipment and prosthetics with no copay and 20% coinsurance, requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
ATRIO Choice Rx (PPO) partially covers diagnostic and radiological services with prior authorization required, though lab services are not covered. Covered diagnostic procedures have no coinsurance and a copay of up to $45, while diagnostic radiology has no copay or coinsurance, outpatient X-rays carry a $15 copay, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by ATRIO Choice Rx (PPO) with no coinsurance, though only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by ATRIO Choice Rx (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $200 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not necessary for admission.
Other Services See details
ATRIO Choice Rx (PPO) covers other services including unlimited acupuncture, an annual wellness exam, post-hospitalization or chronic illness meals, and a $50 quarterly over-the-counter allowance with no copay and no coinsurance. While standard over-the-counter items are covered, nicotine replacement therapy and naloxone are not.
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