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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 Marion and Polk Counties. This plan received an overall rating of 2 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 $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 $9900.00 (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 $9900.00 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:
Sign up for ATRIO Choice Rx (PPO)
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Drug Coverage
The ATRIO Choice Rx (PPO) plan features a $200 annual drug deductible and offers excellent savings on everyday medications. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at standard pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, costing an $8 copay for a 1-month supply and a $16 copay for a 3-month supply. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, while Tier 4 non-preferred drugs carry a $100 copay. If you need a 3-month supply of these medications, you will pay a $94 copay for Tier 3 and a $200 copay for Tier 4 through standard pharmacies or mail order. Specialty medications under Tier 5 require a 30% coinsurance for a 1-month supply.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $40 copay for specialists. For hospital care, inpatient stays require a $450 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services carry a $450 copay. Emergency care is accessible with a $130 copay and urgent care visits require a $50 copay, both with no coinsurance. This plan also includes key supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $300 quarterly limit. Vision and hearing exams are available with a $45 copay, alongside allowances for eyewear and hearing aids. Additionally, members benefit from no copay on up to 24 one-way transportation trips, home health services, and up to $34 quarterly for over-the-counter items.
Inpatient Hospital See details
ATRIO Choice Rx (PPO) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by ATRIO Choice Rx (PPO) with no coinsurance, requiring a $450 copay for outpatient hospital and observation services and a $225 copay for ambulatory surgical center services. Outpatient substance abuse sessions incur a $40 copay and no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by ATRIO Choice Rx (PPO) with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
ATRIO Choice Rx (PPO) covers ground and air ambulance services with a $250 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 trips to any health-related location are not covered.
Emergency Services See details
ATRIO Choice Rx (PPO) covers emergency services with a $130 copay and no coinsurance, and urgent care with a $50 copay and no coinsurance, with copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $250,000 limit with a $300 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
ATRIO Choice Rx (PPO) primary care benefits feature no copay and no coinsurance for primary care doctor visits, while specialist visits, mental health, and psychiatric services require a $40 copay with no coinsurance. Therapy services require a $20 copay with no coinsurance, though podiatry is not covered and chiropractic services are only partially covered since non-routine services are excluded.
Preventive Services See details
Preventive services are partially covered by the ATRIO Choice Rx (PPO) plan with no copay and no coinsurance, including annual physical exams, kidney disease education, diabetes self-management training, glaucoma screenings, alternative therapies, memory fitness, and personal emergency response systems. However, the plan does not cover health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home modifications, or counseling services.
Hearing Services See details
ATRIO Choice Rx (PPO) covers annual routine hearing exams for a $45 copay and no coinsurance, alongside covered hearing aid fittings and evaluations. Prescription hearing aids are partially covered with no coinsurance and copays between $699 and $999 for up to two devices per year, but OTC hearing aids and specific inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by ATRIO Choice Rx (PPO), offering one routine eye exam per year with a $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing annual allowances of up to $100 for contact lenses and $200 for eyeglasses.
Dental Services See details
ATRIO Choice Rx (PPO) offers comprehensive dental services with no copay and no coinsurance for preventive and comprehensive care, including exams, cleanings, implants, and orthodontics. This coverage is subject to a maximum benefit limit of $300 every three months for both in-network and out-of-network services.
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. Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and range from 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 medical equipment with no copays, but a 20% coinsurance applies to durable medical equipment, prosthetic devices, and medical supplies. Diabetic equipment is 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) diagnostic and radiological services are partially covered, as lab services are not covered. Covered diagnostic procedures and tests have no coinsurance and a copay of up to $150, while radiological services require prior authorization and feature a $15 copay for X-rays, no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic 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 the ATRIO Choice Rx (PPO) plan with no copay and no coinsurance, although prior authorization is required. In practice, some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
ATRIO Choice Rx (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay a $10 copay per day for days 1 through 20 and a $150 copay per day for days 21 through 100, though additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
ATRIO Choice Rx (PPO) covers other services including acupuncture, annual wellness visits, and a post-hospitalization meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance up to $34 every three months, excluding nicotine replacement therapy and naloxone.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
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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