ATRIO Choice Rx (PPO)
Medicare Plan Details (2023 Plan)
Monthly Premium
by ATRIO Health Plans
Additional Coverage
Overall Government Star Rating
3.0Ready to Enroll Online?
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
$4,500 In-network
Medical Benefits
Doctor Services
Out-of-network: $50 copay per visit
Out-of-network: $65 copay per visit
Tests, labs, & imaging
Out-of-network: 30% coinsurance
Out-of-network: 15% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Hospital Services
$0 per day for days 6 through 90
Out-of-network: $500 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 50% coinsurance per visit
Skilled nursing facility
$150 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$150 per day for days 21 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $300 copay
Therapy services
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental health services
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Opioid treatment services
Other services
Out-of-network: 30% coinsurance per item
Out-of-network: 30% coinsurance per item
Out-of-network: 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $5.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $45.00 copay | ||
| Non-Preferred Drug | $95.00 copay | ||
| Specialty Tier | 28% |
Part B Drugs
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Extra Benefits
Hearing
Out-of-network: $50 copay
Out-of-network: $0 copay
Out-of-network: $699-999 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Other benefits
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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