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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 Portland Counties and Lane County. 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 $400.00 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 $5500.00 (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 $5500.00 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) Medicare plan features an annual drug deductible of $400. During the initial coverage phase, members benefit from no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions at standard pharmacies and through standard mail order. For brand-name and 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. Additionally, Tier 5 (Specialty Tier) drugs are available at standard pharmacies with a 28% coinsurance for a 1-month supply.
Additional Benefits
ATRIO Choice Rx (PPO) offers comprehensive medical coverage with no copays for primary care visits, preventive services, and home health care. Specialist visits require a $35 copay, while emergency care has a $130 copay and inpatient hospital stays require a $450 daily copay for the first four days. Outpatient hospital services feature no coinsurance, with copays ranging from no copay up to $400. The plan also features valuable supplemental benefits, including dental care with no copay up to $300 every three months and routine vision and hearing exams with no copay. Additionally, members receive a $1,500 annual hearing aid allowance, up to $150 yearly for eyeglasses, and a $50 quarterly over-the-counter item allowance with no copay. Transportation is also covered for up to 12 one-way trips per year with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by ATRIO Choice Rx (PPO) with no coinsurance, requiring prior authorization and a $450 daily copay for days 1 through 4, and no copay for days 5 through 90 for both acute and psychiatric stays. Unlimited additional acute hospital days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by ATRIO Choice Rx (PPO) feature no coinsurance across all services, with outpatient hospital copays ranging from no copay up to $400 and observation services requiring a $450 daily copay. Additionally, ambulatory surgical center services have a $250 copay, outpatient substance abuse sessions carry a $35 copay, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
ATRIO Choice Rx (PPO) covers partial hospitalization services 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, though prior authorization is required. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by ATRIO Choice Rx (PPO) with a $130 copay and no coinsurance, and urgently needed services are covered with a $50 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a maximum benefit limit of $250,000 with a $300 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
ATRIO Choice Rx (PPO) covers primary care physician and occupational therapy services with no copay and no coinsurance, while specialists and psychiatric services require a $35 copay and no coinsurance. Routine chiropractic care is covered with a $15 copay and no coinsurance, but podiatry and non-routine chiropractic services are not covered.
Preventive Services See details
Preventive services under the ATRIO Choice Rx (PPO) plan are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered with no copay and no coinsurance under prior authorization, which includes memory fitness and a personal emergency response system, though services like health education, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
ATRIO Choice Rx (PPO) offers partially covered hearing services with no copay and no coinsurance, including one routine hearing exam per year and unlimited fitting evaluations. While prescription hearing aids are covered up to a $1,500 annual maximum, OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
ATRIO Choice Rx (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered services. Covered benefits include one annual routine eye exam, up to $100 for contact lenses, and up to $150 for eyeglasses (lenses and frames) per year, while other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Dental services are covered by ATRIO Choice Rx (PPO) with no copay and no coinsurance for both preventive and comprehensive care. This benefit has a maximum coverage limit of $300 every three months, which applies to both in-network and out-of-network services.
Home Infusion bundled Services See details
ATRIO Choice Rx (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B drugs, including chemotherapy and radiation, have no copay and a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs have a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by ATRIO Choice Rx (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
ATRIO Choice Rx (PPO) partially covers medical equipment with no copay and a 20% coinsurance required for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Prior authorization is required for these covered services, but diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by ATRIO Choice Rx (PPO), as lab services and outpatient X-ray services are not covered. Covered diagnostic procedures and tests require no coinsurance and a copay ranging from no copay to $20, while therapeutic radiological services have a 20% coinsurance with prior authorization required.
Home Health Services See details
Home health services are covered under the ATRIO Choice Rx (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
ATRIO Choice Rx (PPO) covers cardiac rehabilitation services with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
ATRIO Choice Rx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $200 daily copayment for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
ATRIO Choice Rx (PPO) covers other services including unlimited acupuncture, annual wellness visits, a limited-duration meal benefit, and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $50 every three months, though nicotine replacement therapy and naloxone are not covered.
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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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