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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 Marion and Polk 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8500.00 (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 $8500.00 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 $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, standard generic drugs have a $47 copay, and preferred brand drugs have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D-covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers a range of benefits including coverage for inpatient and outpatient services, with varying copays depending on the specific service. It also includes coverage for ambulance and emergency services, primary care, preventive services with no copay for annual physical exams, and vision and dental services. Additional benefits include hearing services, home health services with no copay, and coverage for medical equipment and diagnostic services. The plan also covers skilled nursing facility services with copays, cardiac rehabilitation services, and other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization, with a $425 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 stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a $425 copay, Ambulatory Surgical Center (ASC) Services with a $225 copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the ATRIO Choice Rx (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the ATRIO Choice Rx (PPO) plan, with a $250 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the ATRIO Choice Rx (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
ATRIO Choice Rx (PPO) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $40 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $20 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
The ATRIO Choice Rx (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services, such as Personal Emergency Response System (PERS), Alternative Therapies, and a Fitness Benefit, are also covered, with the Fitness Benefit offering $225 every six months.
Hearing Services See details
Hearing Services for ATRIO Choice Rx (PPO) include hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $699 and $999 per year for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $45 copay, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades each have a maximum plan benefit coverage amount of $100 or $200 depending on the service.
Dental Services See details
The ATRIO Choice Rx (PPO) plan covers dental services with a maximum benefit of $300 every three months. This plan covers 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the ATRIO Choice Rx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits under the ATRIO Choice Rx (PPO) plan include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. 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 are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by ATRIO Choice Rx (PPO), but no services are covered in practice. 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 with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $150.
Other Services See details
Under the ATRIO Choice Rx (PPO) plan, acupuncture is covered with a maximum benefit coverage amount of $200 every six months, and over-the-counter items are covered up to $25 every three months. Meal benefits are covered, and other services include annual wellness visits. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services like Early and Periodic Screening, Diagnostic, and Treatment Services, Private Duty Nursing Services, and more.
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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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