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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
ATRIO Choice Rx (PPO) is a PPO plan offered by Atrio Health Plans available for the 2026 plan year to people living in Jackson and Josephine Counties. 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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. 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. For Tier 2 generic medications, standard pharmacy costs are an $8 copay for a one-month supply and a $16 copay for a three-month supply. Higher tier medications require a copay or coinsurance, with Tier 3 preferred brands costing a $47 copay for one month and Tier 4 non-preferred drugs requiring a $100 copay for one month. Specialty drugs in Tier 5 incur a 29% coinsurance for a one-month supply at standard pharmacies. Three-month supplies for Tier 3 and Tier 4 drugs are available at standard pharmacies and mail order for a $94 and $200 copay, respectively.
Additional Benefits
The ATRIO Choice Rx (PPO) plan provides comprehensive medical coverage featuring no copay for primary care visits, annual physicals, and home health services. For specialized care, members pay a $40 copay for specialist visits and physical therapy, while emergency room visits carry a $125 copay that is waived if admitted. Inpatient hospital stays require a $450 daily copay for the first five days, after which there is no copay for the remainder of a Medicare-covered stay. This plan also includes valuable supplemental benefits, such as dental care with no copay and no coinsurance up to a $200 quarterly limit. Additionally, members benefit from no copay on prescription hearing aids up to a $1,500 annual limit, a $150 annual allowance for eyewear, and a $60 quarterly allowance for over-the-counter items. Other essential services like durable medical equipment and dialysis are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services under ATRIO Choice Rx (PPO) are partially covered with no coinsurance, requiring a $450 daily copay for days 1 to 5 and no copay for days 6 to 90 for Medicare-covered acute and psychiatric stays. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
ATRIO Choice Rx (PPO) covers outpatient hospital and observation services with a $450 copay and ambulatory surgical center services with a $300 copay, both with no coinsurance. Outpatient substance abuse sessions have a $40 copay and no coinsurance, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the ATRIO Choice Rx (PPO) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
ATRIO Choice Rx (PPO) covers Medicare-covered ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
ATRIO Choice Rx (PPO) covers emergency services with a $125 copay and urgently needed services with a $50 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $250,000 limit with a $125 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
ATRIO Choice Rx (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, occupational and physical therapies, and mental health sessions require a $40 copay and no coinsurance. Routine chiropractic care is partially covered with a $15 copay and no coinsurance (other chiropractic services are not covered), whereas podiatry services are not covered.
Preventive Services See details
ATRIO Choice Rx (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, and Medicare-covered screenings. While alternative therapies and a memory fitness benefit are included, many additional services like health education, therapeutic massage, and in-home safety assessments are not covered.
Hearing Services See details
ATRIO Choice Rx (PPO) hearing services include annual routine exams for a $45 copay and no coinsurance, as well as fitting evaluations and prescription hearing aids with no copay and no coinsurance up to a $1,500 annual limit. OTC hearing aids are not covered, and specific prescription types, including inner ear, outer ear, and over-the-ear devices, are also excluded.
Vision Services See details
Vision Services are partially covered by ATRIO Choice Rx (PPO), featuring a $45 copay and no coinsurance for one routine annual eye exam, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual limit for contact lenses or complete eyeglasses, though 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 care requiring no copay and a 45% coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, subject to a combined in-network and out-of-network maximum benefit of $200 every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance, although prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by ATRIO Choice Rx (PPO) 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. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
ATRIO Choice Rx (PPO) partially covers diagnostic and radiological services, as lab services are not covered under this benefit. Diagnostic procedures and tests require prior authorization and feature no coinsurance with a copay ranging from $0 to $150, while radiological services require prior authorization and carry a $20 copay and coinsurance for X-rays, a minimum 20% coinsurance for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
Home health services are covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by ATRIO Choice Rx (PPO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac ($30 copay), intensive cardiac ($30 copay), pulmonary ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
ATRIO Choice Rx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 copay for days 1 through 20 and a $200 copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are covered under the ATRIO Choice Rx (PPO) with no copay and no coinsurance, including unlimited acupuncture, an annual wellness visit, and a meal benefit with prior authorization. Over-the-counter (OTC) items are partially covered up to $60 every three months with no copay and no coinsurance, though Nicotine Replacement Therapy and Naloxone are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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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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