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ATRIO Special Needs Plan (HMO D-SNP)

Medicare Plan Details (2023 Plan)

Monthly Premium

 

by ATRIO Health Plans
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 3.0
out of 5 stars

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Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

Plan Details

$41
$0
$41
$0 or $505 In-network
$6,700 In-network
No
Yes
Yes
Yes
http://atriohp.com
http://atriohp.com

Medical Benefits

Doctor Services

0% or 20% coinsurance per visit
0% or 20% coinsurance per visit

Tests, labs, & imaging

0% or 20% coinsurance
0% or 20% coinsurance
0% or 20% coinsurance
0% or 20% coinsurance
$0 or $90 copay per visit (always covered)
0% or 20% coinsurance per visit (always covered)

Hospital Services

0% or 7% per day for days 1 through 6
0% or 8% per day for days 7 through 10
0% or 20% per day for days 11 through 90
0% or 20% coinsurance per visit

Skilled nursing facility

0% per day for days 1 through 20
0% or 10% per day for days 21 through 100

Preventive services

$0 copay

Ambulance

0% or 20% coinsurance

Therapy services

0% or 20% coinsurance
0% or 20% coinsurance

Mental health services

0% or 20% coinsurance
0% or 20% coinsurance
0% or 20% coinsurance
0% or 20% coinsurance

Opioid treatment services

Covered

Other services

0% or 15% coinsurance per item
0% or 15% coinsurance per item
$0 copay

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

0% or 10% coinsurance
0% or 10% coinsurance

Extra Benefits

Hearing

0% or 20% coinsurance
Not covered
Not covered
Not covered
Not covered

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Not covered
Limited coverage

Health Plan Star Ratings

(government star ratings are out of 5 stars)
 3
 2
 3
 3
 4
No Rating (new plans)

Prescription Drug Plan Star Ratings

(government star ratings are out of 5 stars)
 3
 4
 4
 3
 3

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 

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