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ATRIO Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ATRIO Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ATRIO Freedom (PPO) in 2025, please refer to our full plan details page.
ATRIO Freedom (PPO) is a PPO plan offered by ATRIO Health Plans available for enrollment in 2025 to people living in Klamath. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that ATRIO Freedom (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about ATRIO Freedom (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 Freedom (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 has a $110.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by ATRIO Freedom (PPO).
Additional Benefits
The ATRIO Freedom (PPO) plan offers coverage for a range of services, including inpatient and outpatient hospital care, with copays applying to specific services. You'll pay a copay for primary care visits, specialist visits, mental health services, and physical therapy. Additionally, the plan covers preventive services with no copay, hearing and vision services with copays, and dental services with a maximum benefit. This plan also provides benefits for ambulance services, emergency services, and home health services with no copay, and offers coverage for home infusion bundled services, dialysis, medical equipment, and diagnostic services with varying cost-sharing. Other benefits include acupuncture, OTC items, and a meal benefit. However, the plan does not cover certain services like cardiac rehabilitation, and specific services like podiatry and certain types of hearing aids are not included.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-7, and no copay for days 8-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include Outpatient Hospital Services with 20% coinsurance, Observation Services with a $275 copay per day, Ambulatory Surgical Center (ASC) Services with 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance for individual and group sessions, and Outpatient Blood Services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the ATRIO Freedom (PPO) plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the ATRIO Freedom (PPO) plan. Ground and Air Ambulance Services have a $275 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the ATRIO Freedom (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $55 copay, with no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The ATRIO Freedom (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, mental health and psychiatric services with a $25 copay, physical therapy and speech-language pathology services with a $25 copay, and opioid treatment program services with 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The ATRIO Freedom (PPO) plan covers preventive services, including annual physical exams with no copay. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are also covered, with no copay. Some services, such as health education, in-home safety assessments, and medical nutrition therapy, are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $45 copay, and prescription hearing aids with a copay between $699 and $999. Routine hearing exams are limited to 1 per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids are limited to 2 per year. Inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $45 copay, and eyewear. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay, and other dental services with a maximum benefit of $300 every six months. 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 are covered, along with orthodontic services covered under Diagnostic and Preventive Dental (16b).
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the ATRIO Freedom (PPO) plan. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the ATRIO Freedom (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with a $20 copay, Diagnostic Radiological Services with up to 20% coinsurance, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $20 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the ATRIO Freedom (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 Freedom (PPO) plan. Prior authorization is required for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ATRIO Freedom (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The ATRIO Freedom (PPO) plan covers acupuncture with a maximum benefit coverage amount of $100 every six months, and also covers over-the-counter (OTC) items with a maximum benefit of $25 every three months. The plan also covers a meal benefit, and one annual wellness visit per calendar year. However, this plan does not cover the following: Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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