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
3.0out 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
Plan Details
$0
$0
$0
$110 annual deductible
$6,500 In and Out-of-network
$4,500 In-network
$4,500 In-network
No
Yes
No
No
Medical Benefits
Doctor Services
In-network: $10 copay per visit
Out-of-network: $50 copay per visit
Out-of-network: $50 copay per visit
In-network: $25 copay per visit
Out-of-network: $65 copay per visit
Out-of-network: $65 copay per visit
Tests, labs, & imaging
In-network: $20 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $20 copay
Out-of-network: 15% coinsurance
Out-of-network: 15% coinsurance
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $20 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
$90 copay per visit (always covered)
$35 copay per visit (always covered)
Hospital Services
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
$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
In-network: 20% coinsurance per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
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
$150 per day for days 21 through 100
Out-of-network: $150 per day for days 1 through 100
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
In-network: $275 copay
Out-of-network: $275 copay
Out-of-network: $275 copay
Therapy services
In-network: $25 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $25 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental health services
In-network: $25 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $25 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $25 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $25 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Opioid treatment services
Covered
Other services
In-network: 15% coinsurance per item
Out-of-network: 30% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 15% coinsurance per item
Out-of-network: 30% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: $0 copay
Out-of-network: 20% 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
Part B Drugs
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Extra Benefits
Hearing
In-network: $45 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Not covered
Not covered
Not covered
Not covered
Preventive Dental
Not covered
Not covered
Not covered
Not covered
Comprehensive dental
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Vision
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Other benefits
Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Not covered
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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