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ATRIO Select Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ATRIO Select Rx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ATRIO Select Rx (PPO) in 2025, please refer to our full plan details page.
ATRIO Select 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 Select 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 Select 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 Select Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 Select Rx (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier. For example, there is no copay for preferred generic drugs at a standard pharmacy, a $35 copay for standard generic drugs, and a $100 copay for preferred brand drugs. In the catastrophic coverage phase, after your yearly out-of-pocket drug costs reach $2000, you will 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 Select Rx (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a $250 copay for the first five days, and outpatient services with varying copays. You'll find coverage for emergency services with a $140 copay, along with primary care visits at no copay. This plan also includes benefits for hearing, vision, and dental services, such as routine exams and coverage for hearing aids, eyeglasses, and a range of dental procedures. Additionally, you'll have access to home health services at no copay, and skilled nursing facility care with copays depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric services, with a $250 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 for inpatient hospital-acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay between $0 and $350, observation services with a copay between $0 and $250, ambulatory surgical center services with a $125 copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the ATRIO Select Rx (PPO) plan with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for both ground and air ambulance services, each with a $300 copay, and transportation services to a plan-approved health-related location with up to 24 one-way trips per year, but transportation services to any other health-related location are not covered. Prior authorization is required for all ambulance services.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Coverage, are covered under the ATRIO Select Rx (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $30 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered, but the plan provides up to $250,000 for Worldwide Emergency Services.
Primary Care See details
The ATRIO Select Rx (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $10 copay for routine care, up to a maximum of $100 every six months. Occupational Therapy Services has no copay, while Physician Specialist Services has a $25 copay. Mental Health Specialty Services and Psychiatric Services have a $10 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have no copay. Additional Telehealth Benefits have a 0-25% coinsurance, and Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
The ATRIO Select Rx (PPO) plan covers preventive services including Medicare-covered services, annual physical exams, and additional preventive services. This plan also covers Personal Emergency Response Systems (PERS) with a maximum benefit coverage amount of $18.50 every month, Alternative Therapies up to $100 every six months, and a Fitness Benefit (Memory Fitness) up to $225 every six months.
Hearing Services See details
Hearing services include routine hearing exams (1 per year), and fitting/evaluation for hearing aids with no copay or coinsurance, as well as prescription hearing aids up to $1,500 per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
The ATRIO Select Rx (PPO) plan covers vision services, including routine eye exams with one visit allowed every year, and eyewear. Eyewear includes contact lenses with one pair allowed every year, eyeglasses (lenses and frames) with one pair allowed every year up to $200, and upgrades. Eyeglass lenses and frames are not covered.
Dental Services See details
The ATRIO Select Rx (PPO) plan covers a range of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, with a maximum benefit of $400 every three months and prior authorization required for all services. Additionally, orthodontic services, restorative services, and other services are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the ATRIO Select Rx (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all services. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the ATRIO Select Rx (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetics/Medical Supplies with a coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the ATRIO Select Rx (PPO) plan, but Diagnostic Procedures/Tests, and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $60, and Therapeutic Radiological Services have a copay of at most $20, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the ATRIO Select Rx (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the ATRIO Select Rx (PPO) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $170; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The ATRIO Select Rx (PPO) plan covers acupuncture with a maximum benefit of $100 every six months. Over-the-counter (OTC) items are covered with a maximum benefit of $100 every three months, and the plan provides a meal benefit after surgery or inpatient hospitalization, and for chronic illnesses. Other services like 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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