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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 Jackson and Josephine Counties. 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 $200.00 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 $7900.00 (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 $7900.00 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 $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay an $8 copay for a preferred generic drug at a standard pharmacy, and a $100 copay for a preferred brand drug at a standard pharmacy. The plan offers no copay for specialty tier drugs at a standard pharmacy.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers a range of benefits beyond standard Medicare, with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. Emergency and ambulance services have copays, and primary care, including chiropractic and mental health, has a $20-$40 copay. Preventive services, including annual physical exams, have no copay. The plan also covers hearing, vision, and dental services with copays or coinsurance. Additional benefits include home health services with no copay, and coverage for home infusion, dialysis, and medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage under the ATRIO Choice Rx (PPO) plan includes acute and psychiatric care. For days 1-5, there is a $450 copay, and there is no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $450 copay, observation services with a $450 copay, ambulatory surgical center services with a $300 copay, and outpatient substance abuse services with a $40 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under 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 under the ATRIO Choice Rx (PPO) plan. Ground and Air Ambulance Services have a $275 copay, with no coinsurance, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $125, $55, and $125 respectively, with no coinsurance. Worldwide Urgent Coverage also has a $125 copay with 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 $40 copay, Physician Specialist Services with a $40 copay, Mental Health Specialty Services with a $40 copay, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with a copay between $0 and $40, and Opioid Treatment Program Services with a $40 copay. Podiatry Services are not covered.
Preventive Services See details
ATRIO Choice Rx (PPO) covers preventive services, including annual physical exams, with no copay or coinsurance. This plan also covers additional preventive services like alternative therapies and fitness benefits, with a maximum plan benefit coverage amount of $300.00 every six months for alternative therapies and $250.00 every six months for fitness benefits. However, services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids are covered up to a maximum of $1500 per year for both ears combined, while inner ear, outer ear, and over the ear prescription hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
The ATRIO Choice Rx (PPO) plan covers vision services, including routine eye exams with a $45 copay. Eyewear is covered up to a combined maximum of $150 per year for both in-network and out-of-network services, and contact lenses and eyeglasses (lenses and frames) are covered, each limited to one per year. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered under the ATRIO Choice Rx (PPO) plan, with a 45% coinsurance for Medicare Dental Services and a maximum benefit of $200 every three months for other dental services. Other services such as oral exams, dental x-rays, and orthodontics are unlimited.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the ATRIO Choice Rx (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the ATRIO Choice Rx (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits with the ATRIO Choice Rx (PPO) plan include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered items, and Diabetic Equipment. Durable Medical Equipment for use outside the home and Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the ATRIO Choice Rx (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $20, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $150, Therapeutic Radiological Services have a minimum copay of $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the ATRIO Choice Rx (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the sub-services of 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. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the ATRIO Choice Rx (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $200 copay.
Other Services See details
The ATRIO Choice Rx (PPO) plan covers acupuncture with a maximum plan benefit coverage amount of $300.00 every six months, and over-the-counter items with a maximum plan benefit coverage amount of $50.00 every three months. The plan also covers a meal benefit, but requires prior authorization. Other services like 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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