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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 Washoe. 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 $6200.00 (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 $6200.00 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. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $12 copay for preferred generic drugs at a standard pharmacy. For standard generic drugs, the copay is $47. For preferred brand drugs, the copay is $100. Non-preferred drugs have a 33% coinsurance. The specialty tier has no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The ATRIO Choice Rx (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have no copay, and the plan covers outpatient services with copays ranging from $0 to $400. Emergency services have a $140 copay, and urgent care has a $65 copay. The plan includes primary care, preventive, hearing, vision, and dental services. Many services, such as hearing exams, and some home health services have no copay. The plan also offers coverage for ambulance, transportation, and other services like acupuncture, and over-the-counter items, with specific copays or coverage limits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with no copay for a Medicare-covered stay, and additional days for Inpatient Hospital-Acute are covered with no copay. Inpatient Hospital Psychiatric has a $300 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a copay between $0 and $400, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services, individual sessions, and group sessions each have a copay between $10 and $10. 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, including services not usually covered by Medicare, are covered by ATRIO Choice Rx (PPO). Ground and Air Ambulance Services have a $300 copay, and Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the ATRIO Choice Rx (PPO) plan with a $140 copay and no coinsurance, while Urgently Needed Services have a $65 copay with no coinsurance. Worldwide Emergency Coverage has a $135 copay, and Worldwide Urgent Coverage has a $140 copay; both have 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 $10 copay, occupational therapy services, physician specialist services with a $25 copay, mental health specialty services with a $10 copay, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with a $0-$25 copay, and opioid treatment program services with a $10 copay. Podiatry services are not covered.
Preventive Services See details
The ATRIO Choice Rx (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and other preventive services requiring prior authorization. The plan also covers Personal Emergency Response Systems, Alternative Therapies, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs.
Hearing Services See details
Hearing Services are covered by the ATRIO Choice Rx (PPO) plan, including routine hearing exams and fitting/evaluation for hearing aids, with no copay. The plan covers prescription hearing aids up to $1,500 every year. OTC hearing aids, as well as prescription hearing aids for the inner and outer ear, and over the ear, are not covered.
Vision Services See details
The ATRIO Choice Rx (PPO) plan covers routine eye exams once per year and eyewear benefits, including eyeglasses (lenses and frames) with a maximum benefit of $150 per year, and contact lenses with a maximum benefit of $100 per year. However, eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
The ATRIO Choice Rx (PPO) plan covers a variety of dental services, including oral exams, x-rays, cleanings, and more, up to a maximum of $400 every three months. Orthodontic services are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
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 are covered under the ATRIO Choice Rx (PPO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Medical Supplies have a 20% coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by ATRIO Choice Rx (PPO), but some services are not covered. Diagnostic Radiological Services have a copay of at most $60.00, and Therapeutic Radiological Services have a copay of at most $20.00, while Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the ATRIO Choice Rx (PPO) plan, but all of the listed sub-services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ATRIO Choice Rx (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $170.
Other Services See details
The ATRIO Choice Rx (PPO) plan covers acupuncture with a maximum benefit coverage amount of $300.00 every six months, and also covers over-the-counter items up to $75.00 every three months. The plan also covers a meal benefit, and annual wellness visits. However, 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 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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