ATRIO Choice (PPO)
H6743 - 022 - 2
(3.5 / 5)
ATRIO Choice (PPO) is a Medicare Advantage Plan by ATRIO Health Plans.
This page features plan details for 2022 ATRIO Choice (PPO) H6743 – 022 – 2.
IMPORTANT: This page features the 2022 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
ATRIO Choice (PPO) is offered in the following locations.
Plan Overview
ATRIO Choice (PPO) offers the following coverage and cost-sharing.
| Insurer: | ATRIO Health Plans |
| Health Plan Deductible: | $0 |
| MOOP: | $4,500.00 |
| Drugs Covered: | No |
Ready to sign up for ATRIO Choice (PPO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
ATRIO Choice (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $170.10 | $0.00 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
ATRIO Choice (PPO) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Diagnostic services: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
| Endodontics: | In-Network: $0 copay (limits may apply) (authorization required) |
| Endodontics: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
| Extractions: | In-Network: $0 copay (limits may apply) (authorization required) |
| Extractions: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
| Non-routine services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Non-routine services: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
| Periodontics: | In-Network: $0 copay (limits may apply) (authorization required) |
| Periodontics: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
| Restorative services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Restorative services: | Out-of-Network: $0 copay (limits may apply) (authorization required) |
Dental (preventive)
| Cleaning: | In-Network: $0 copay (limits may apply) |
| Cleaning: | Out-of-Network: $0 copay (limits may apply) |
| Dental x-ray(s): | In-Network: $0 copay (limits may apply) |
| Dental x-ray(s): | Out-of-Network: $0 copay (limits may apply) |
| Fluoride treatment: | In-Network: $0 copay (limits may apply) |
| Fluoride treatment: | Out-of-Network: $0 copay (limits may apply) |
| Oral exam: | In-Network: $0 copay (limits may apply) |
| Oral exam: | Out-of-Network: $0 copay (limits may apply) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | In-Network: 20% coinsurance (authorization required) |
| Diagnostic radiology services (e.g., MRI): | Out-of-Network: 30% coinsurance (authorization required) |
| Diagnostic tests and procedures: | In-Network: $20 copay (authorization required) |
| Diagnostic tests and procedures: | Out-of-Network: 30% coinsurance (authorization required) |
| Lab services: | In-Network: $20 copay (authorization required) |
| Lab services: | Out-of-Network: 15% coinsurance (authorization required) |
| Outpatient x-rays: | In-Network: $20 copay (authorization required) |
| Outpatient x-rays: | Out-of-Network: 30% coinsurance (authorization required) |
Doctor visits
| Primary: | In-Network: $10 copay per visit |
| Primary: | In-Network: $0 copay |
| Primary: | Out-of-Network: $50 copay per visit |
| Primary: | Out-of-Network: $40 copay per visit |
| Specialist: | In-Network: $25 copay per visit |
| Specialist: | In-Network: $45 copay per visit |
| Specialist: | Out-of-Network: $50 copay per visit |
| Specialist: | Out-of-Network: $65 copay per visit |
Emergency care/Urgent care
| Emergency: | $90 copay per visit (always covered) |
| Urgent care: | $25 copay per visit (always covered) |
| Urgent care: | $35 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | In-Network: $25 copay |
| Foot exams and treatment: | In-Network: $45 copay |
| Foot exams and treatment: | Out-of-Network: 0-50% coinsurance |
| Foot exams and treatment: | Out-of-Network: 50% coinsurance |
| Routine foot care: | Not covered |
Ground ambulance
| In-Network: $275 copay | |
| In-Network: $250 copay | |
| Out-of-Network: $250 copay | |
| Out-of-Network: $275 copay |
Health plan deductible
| $110 annual deductible | |
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | In-Network: $0 copay |
| Fitting/evaluation: | Out-of-Network: $45 copay |
| Hearing aids: | In-Network: $699-999 copay (limits may apply) |
| Hearing aids: | Out-of-Network: $699-999 copay (limits may apply) |
| Hearing exam: | In-Network: $45 copay |
| Hearing exam: | Out-of-Network: $50 copay |
Hospital coverage (inpatient)
| In-Network: $275 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) | |
| In-Network: $300 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) | |
| Out-of-Network: $375 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) |
Hospital coverage (outpatient)
| In-Network: 20% coinsurance per visit (authorization required) | |
| In-Network: $325 copay per visit (authorization required) | |
| Out-of-Network: 30% coinsurance per visit (authorization required) | |
| Out-of-Network: $425 copay per visit (authorization required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $6,500 In and Out-of-network $4,500 In-network |
Medical equipment/supplies
| Diabetes supplies: | In-Network: $0 copay (authorization required) |
| Diabetes supplies: | Out-of-Network: 20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 15% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 40% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 30% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | In-Network: 15% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 40% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 30% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
| Chemotherapy: | Out-of-Network: 0-50% coinsurance (authorization required) |
| Chemotherapy: | Out-of-Network: 50% coinsurance (authorization required) |
| Other Part B drugs: | In-Network: 20% coinsurance (authorization required) |
| Other Part B drugs: | Out-of-Network: 0-50% coinsurance (authorization required) |
| Other Part B drugs: | Out-of-Network: 50% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | In-Network: $225 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) |
| Inpatient hospital – psychiatric: | In-Network: $250 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) |
| Inpatient hospital – psychiatric: | Out-of-Network: $375 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) |
| Outpatient group therapy visit with a psychiatrist: | In-Network: $40 copay |
| Outpatient group therapy visit with a psychiatrist: | In-Network: $25 copay |
| Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 50% coinsurance |
| Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 0-50% coinsurance |
| Outpatient group therapy visit: | In-Network: $25 copay |
| Outpatient group therapy visit: | In-Network: $40 copay |
| Outpatient group therapy visit: | Out-of-Network: 0-50% coinsurance |
| Outpatient group therapy visit: | Out-of-Network: 50% coinsurance |
| Outpatient individual therapy visit with a psychiatrist: | In-Network: $25 copay |
| Outpatient individual therapy visit with a psychiatrist: | In-Network: $40 copay |
| Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 0-50% coinsurance |
| Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 50% coinsurance |
| Outpatient individual therapy visit: | In-Network: $25 copay |
| Outpatient individual therapy visit: | In-Network: $40 copay |
| Outpatient individual therapy visit: | Out-of-Network: 0-50% coinsurance |
| Outpatient individual therapy visit: | Out-of-Network: 50% coinsurance |
Optional supplemental benefits
| No |
Preventive care
| In-Network: $0 copay | |
| Out-of-Network: $0 copay |
Rehabilitation services
| Occupational therapy visit: | In-Network: $40 copay (authorization required) |
| Occupational therapy visit: | In-Network: $25 copay (authorization required) |
| Occupational therapy visit: | Out-of-Network: 50% coinsurance (authorization required) |
| Occupational therapy visit: | Out-of-Network: 0-50% coinsurance (authorization required) |
| Physical therapy and speech and language therapy visit: | In-Network: $40 copay (authorization required) |
| Physical therapy and speech and language therapy visit: | In-Network: $25 copay (authorization required) |
| Physical therapy and speech and language therapy visit: | Out-of-Network: 0-50% coinsurance (authorization required) |
| Physical therapy and speech and language therapy visit: | Out-of-Network: 50% coinsurance (authorization required) |
Skilled Nursing Facility
| In-Network: $0 per day for days 1 through 20 $125 per day for days 21 through 100 (authorization required) | |
| In-Network: $0 per day for days 1 through 20 $150 per day for days 21 through 100 (authorization required) | |
| Out-of-Network: $150 per day for days 1 through 100 (authorization required) | |
| Out-of-Network: $125 per day for days 1 through 100 (authorization required) |
Transportation
| Not covered |
Vision
| Contact lenses: | In-Network: $0 copay (limits may apply) |
| Contact lenses: | Out-of-Network: 0-50% coinsurance (limits may apply) |
| Eyeglass frames: | Not covered |
| Eyeglass lenses: | Not covered |
| Eyeglasses (frames and lenses): | In-Network: $0 copay (limits may apply) |
| Eyeglasses (frames and lenses): | Out-of-Network: 0-50% coinsurance (limits may apply) |
| Other: | Not covered |
| Routine eye exam: | In-Network: $0 copay (limits may apply) |
| Routine eye exam: | Out-of-Network: 0-50% coinsurance (limits may apply) |
| Upgrades: | In-Network: $0 copay (limits may apply) |
| Upgrades: | Out-of-Network: 0-50% coinsurance (limits may apply) |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Ready to sign up for ATRIO Choice (PPO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST