ATRIO Special Needs Plan (HMO D-SNP)
Oregon Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
2.5
out of 5 stars
Plan Name
ATRIO Special Needs Plan (HMO D-SNP)
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
ATRIO Special Needs Plan (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Oregon and offered by the health insurance company ATRIO Health Plans. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Annual Deductible
Coming soon
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
$0 or $110 copay per visit (always covered)
Ambulance
0% or 20% coinsurance
ATRIO Special Needs Plan (HMO D-SNP) has a monthly premium cost of $26 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for ATRIO Special Needs Plan (HMO D-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
ATRIO Special Needs Plan (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. ATRIO Special Needs Plan (HMO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. ATRIO Special Needs Plan (HMO D-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, ATRIO Special Needs Plan (HMO D-SNP) received an overall government quality rating of 2.5 stars out of 5 stars.
ATRIO Special Needs Plan (HMO D-SNP) performed worse than Oregon’s State average overall quality score of 3.2 stars.
This Plan’s 5-star Gov’t Quality Score
Oregon State Average Score
Overall Government 5 Star Quality Rating
2.5
3.2
Summary rating of health plan quality
Staying healthy: screenings, tests, & vaccines
Managing chronic (long term) conditions
Member experience with health plan
Member complaints & changes in the health plan's performance
Health plan customer service
Summary rating of drug plan quality
Drug plan customer service
Member complaints & changes in the drug plan's performance
Member experience with the drug plan
Drug safety & accuracy of drug pricing
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
ATRIO Special Needs Plan (HMO D-SNP) received 2.5 stars for its health plan quality score which is worse than the Oregon State average health plan quality score of 2.9 stars.
ATRIO Special Needs Plan (HMO D-SNP) received 3 stars for its drug plan quality score which is worse than the Oregon State average drug plan quality score of 3.3 stars.
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Emergency care
$0 or $110 copay per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
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
Outpatient hospital coverage
0% or 20% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
0% per day for days 1 through 20
0% or 10% per day for days 21 through 100
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
0% or 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
0% or 20% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|
Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
Generic |
Preferred Brand |
Non-Preferred Drug |
Specialty Tier |
Part B Drugs
Hearing
Hearing aids - Over the ear
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Eyeglasses (frames & lenses)
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