ATRIO Bronze (PPO) | Medicare Plan Details & Help | OR | Health Plan Radar

ATRIO Bronze (PPO)

Medicare Plan Details

2021 Plan

Monthly Premium

(select county for price)

by ATRIO Health Plans

Additional Coverage

Hearing

Overall Government Star Rating

3.0

out of 5 stars

State: Oregon

Select your county to view the price for this plan

Plan Type

Medicare Advantage (Part C)

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

Monthly Premium

$0

Health Portion of Premium

$0

Drug Portion of Premium

$0

Health Plan Deductible

$110 annual deductible

Health Plan Max Out-of-Pocket

$6,500 In and Out-of-network
$4,500 In-network

Nationwide Coverage included

No

Hearing Coverage included

Yes

Vision Coverage included

No

Dental Coverage included

No

Doctor Lookup Link

http://atriohp.com

Plan Link

http://atriohp.com

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $10 copay per visit
Out-of-network: $50 copay per visit

Specialist visit

In-network: $25 copay per visit
Out-of-network: $65 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $20 copay
Out-of-network: 30% coinsurance

Lab services

In-network: $20 copay
Out-of-network: 15% coinsurance

Diagnostic radiology services (like MRI)

In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Outpatient x-rays

In-network: $20 copay
Out-of-network: 30% coinsurance

Emergency care

$90 copay per visit (always covered)

Urgent care

$35 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $275 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-network: $375 per day for days 1 through 7
$0 per day for days 8 through 90

Outpatient hospital coverage

In-network: 20% coinsurance per visit
Out-of-network: 30% coinsurance per visit

Skilled nursing facility

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$150 per day for days 21 through 100
Out-of-network: $150 per day for days 1 through 100

Preventive services

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance

In-network: $275 copay
Out-of-network: $275 copay

Therapy services

Occupational therapy visit

In-network: $25 copay
Out-of-network: 50% coinsurance

Physical therapy & speech & language therapy visit

In-network: $25 copay
Out-of-network: 50% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $25 copay
Out-of-network: 50% coinsurance

Outpatient individual therapy with a psychiatrist

In-network: $25 copay
Out-of-network: 50% coinsurance

Outpatient group therapy visit

In-network: $25 copay
Out-of-network: 50% coinsurance

Outpatient individual therapy visit

In-network: $25 copay
Out-of-network: 50% coinsurance

Opioid treatment services

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 15% coinsurance per item
Out-of-network: 30% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 15% coinsurance per item
Out-of-network: 30% coinsurance per item

Diabetes supplies

In-network: $0 copay
Out-of-network: 20% coinsurance per item

Prescription Drug Benefits

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

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 50% coinsurance

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: 50% coinsurance

Extra Benefits

Hearing

Hearing exam

In-network: $45 copay
Out-of-network: $50 copay

Fitting/evaluation

Not covered

Hearing aids - Inner ear

Not covered

Hearing aids - Outer ear

Not covered

Hearing aids - Over the ear

Not covered

Preventive Dental

Oral exam

Not covered

Cleaning

Not covered

Fluoride treatment

Not covered

Dental x-rays

Not covered

Comprehensive dental

Non-routine services

Not covered

Diagnostic services

Not covered

Restorative services

Not covered

Endodontics

Not covered

Periodontics

Not covered

Extractions

Not covered

Prosthodontics, other oral/maxillofacial surgery, other services

Not covered

Vision

Routine eye exam

Not covered

Contact lenses

Not covered

Eyeglasses (frames & lenses)

Not covered

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Not covered

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Not covered

Annual physical exams

Limited coverage

Telehealth

Not covered

Summary rating of health plan quality

3

Staying healthy: screenings, tests, & vaccines

2

Managing chronic (long term) conditions

2

Member experience with health plan

3

Member complaints & changes in the health plan's performance

4

Health plan customer service

3

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