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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 Portland Counties and Lane County. 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 $4150.00 (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 $4150.00 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 no deductible for prescription drugs. In the initial coverage phase, you may pay a copay of $0 for preferred generic drugs at a standard pharmacy, $47 for standard generic drugs, $100 for preferred brand drugs, and 33% coinsurance for non-preferred drugs. There is also no copay for specialty drugs at a standard pharmacy. 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 inpatient and outpatient hospital services, with varying copays. You will pay a copay for emergency services, and transportation services are limited to 12 one-way trips per year. Additionally, the plan covers primary care, preventive services, hearing, vision, and dental services with specific copays and maximum benefit amounts for certain services. This plan also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services with associated cost-sharing, such as coinsurance. Home health services have no copay or coinsurance, but require prior authorization. Furthermore, the plan covers acupuncture, over-the-counter items, and meal benefits, with some services requiring prior authorization or having maximum benefit limits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you will pay a $375 copay for days 1-4, and no copay for days 5-90, while psychiatric care has the same cost sharing structure.
Outpatient Services See details
Outpatient Services include coverage for hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $350, Observation Services have a copay of $375, Ambulatory Surgical Center Services have a copay of $250, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.
Partial Hospitalization See details
Partial hospitalization is covered with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, 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 12 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency services, including urgently needed services and worldwide emergency coverage, are covered by the ATRIO Choice Rx (PPO) plan. Emergency services and worldwide emergency coverage have a $140 copay, and urgently needed services have a $60 copay, but there is no coinsurance for any of these services. Worldwide emergency transportation is not covered.
Primary Care See details
The ATRIO Choice Rx (PPO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with no copay or coinsurance, Physician Specialist Services with a $25 copay, and Mental Health Specialty Services with a $20 copay for individual and group sessions. This plan also covers Physical Therapy and Speech-Language Pathology Services with no coinsurance and no copay, Additional Telehealth Benefits with a copay between $0 and $25, and Opioid Treatment Program Services with a $20 copay.
Preventive Services See details
The ATRIO Choice Rx (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services that require prior authorization. The plan also covers Personal Emergency Response System (PERS) with a maximum benefit of $18.50 per month, Alternative Therapies up to $100 every six months, and Fitness Benefit with memory fitness with a maximum benefit of $175 every six months; however, Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the ATRIO Choice Rx (PPO) plan. This includes routine hearing exams, and fitting/evaluation for hearing aids, and prescription hearing aids, with a maximum benefit of $1500 every year for both in-network and out-of-network services; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The ATRIO Choice Rx (PPO) plan covers vision services, including routine eye exams with one visit per year and eyewear benefits. Eyeglasses (lenses and frames) are covered with a maximum plan benefit coverage amount of $150.00 every year, and contact lenses are covered with a maximum plan benefit coverage amount of $100.00 per year.
Dental Services See details
Dental services are covered under the ATRIO Choice Rx (PPO) plan, with a maximum benefit of $500 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 all covered with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the ATRIO Choice Rx (PPO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the ATRIO Choice Rx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment with a coinsurance, but Diabetic Supplies and Durable Medical Equipment for use outside the home are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the ATRIO Choice Rx (PPO) plan. Diagnostic services, including procedures/tests and lab services, are not covered. Diagnostic Radiological Services have a copay of up to $300, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the ATRIO Choice Rx (PPO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the ATRIO Choice Rx (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the ATRIO Choice Rx (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $200. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The ATRIO Choice Rx (PPO) plan covers acupuncture with a maximum plan benefit coverage amount of $100 every six months, and over-the-counter items with a maximum benefit of $50 every three months. Meal benefits are covered and require prior authorization. Annual Wellness Visits are covered once per calendar year. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others 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.
* 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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