2027 Medicare Advantage plan

ATRIO Freedom (PPO): 2027 benefits and costs

ATRIO Health Plans PPO

CMS plan ID: H7006-021-0 · Plan year: 2027

ATRIO Freedom (PPO) is a 2027 Medicare Advantage plan offered by ATRIO Health Plans. It is listed in Oregon.

2027 plan costs at a glance

Monthly plan premium$0.00
In-network medical out-of-pocket maximum$4,450.00
Organization
ATRIO Health Plans
Plan organization
ATRIO HEALTH PLANS
Parent company
ATRIO Health Plans
Plan type
PPO
Part C premium
$0.00
Prescription drug coverage
No
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

Annual medical deductible
None
In-network medical maximum
$4,450.00
Combined in/out-of-network medical maximum
$4,450.00
Out-of-network medical maximum
Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkOut-of-networkWhat to know
Primary care doctor

$0

Service-specific deductible
No

$50.00 copay

Deductible applies
No
Specialist visit

$40.00 copay

Service-specific deductible
No

$50.00 copay

Deductible applies
No
Approval required
No
Referral required
No
Telehealth

$0.00 to $40.00 copay

Service-specific deductible
No

Not summarized. Check coverage with the plan.

Approval required
No
Referral required
No
Emergency care

$150.00 copay

Not summarized. Check coverage with the plan.

Urgent care

$50.00 copay

Not summarized. Check coverage with the plan.

Home health

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

$0

Service-specific deductible
No

$0

Deductible applies
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$10.00 copay

Service-specific deductible
No

$10.00 copay

Deductible applies
No
Approval required
No
Referral required
No
Medicare-covered foot care

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Other health professionals

$0.00 to $40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–5: $250.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare
Inpatient mental health care

$0.00 copay per stay

Days 1–5: $250.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–100: $100.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkOut-of-networkWhat to know
Outpatient hospital care

$350.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Hospital observation services

$100.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Ambulatory surgical center

$250.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Outpatient blood

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkOut-of-networkWhat to know
Diagnostic procedures and tests

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Laboratory services

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$0.00 to $60.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Therapeutic radiology

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
X-rays

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkOut-of-networkWhat to know
Partial hospitalization

$55.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Intensive outpatient program

$55.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Substance use treatment, individual sessions

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Substance use treatment, group sessions

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Opioid treatment program

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Mental health, individual sessions

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Mental health, group sessions

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Psychiatry, individual sessions

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Psychiatry, group sessions

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkOut-of-networkWhat to know
Occupational therapy

$20.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Physical and speech therapy

$20.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Cardiac rehabilitation

$5.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Intensive cardiac rehabilitation

$5.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Pulmonary rehabilitation

$5.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Supervised exercise for peripheral artery disease

$5.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkOut-of-networkWhat to know
Ground ambulance

$300.00 copay

Service-specific deductible
No

$300.00 copay

Deductible applies
No
Approval required
Yes
Air ambulance

$300.00 copay

Service-specific deductible
No

$300.00 copay

Deductible applies
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic supplies

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic monitors

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Medicare-covered dental

$0

50% coinsurance

Deductible applies
No
Oral examsAdditional plan benefit

$0

$0

Deductible applies
No
Dental X-raysAdditional plan benefit

$0

$0

Deductible applies
No
Other diagnostic dentalAdditional plan benefit

$0

$0

Deductible applies
No
Dental cleaningAdditional plan benefit

$0

$0

Deductible applies
No
FluorideAdditional plan benefit

$0

$0

Deductible applies
No
Other preventive dentalAdditional plan benefit

$0

$0

Deductible applies
No
Restorative dental careAdditional plan benefit

$0

$0

Deductible applies
No
Root canal treatment (endodontics)Additional plan benefit

$0

$0

Deductible applies
No
Gum treatment (periodontics)Additional plan benefit

$0

$0

Deductible applies
No
Removable dentures (prosthodontics)Additional plan benefit

$0

$0

Deductible applies
No
Maxillofacial prostheticsAdditional plan benefit

$0

$0

Deductible applies
No
Dental implantsAdditional plan benefit

$0

$0

Deductible applies
No
Fixed dental restorations (prosthodontics)Additional plan benefit

$0

$0

Deductible applies
No
Oral surgeryAdditional plan benefit

$0

$0

Deductible applies
No
OrthodonticsAdditional plan benefit

$0

$0

Deductible applies
No
Other dental servicesAdditional plan benefit

$0

$0

Deductible applies
No

Additional network details

These costs apply to the listed service categories and networks.

Dental benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Diagnostic and preventive dental (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Comprehensive dental (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Vision benefits

Vision benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Medicare-covered eye exams

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$0

80% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Medicare-covered eyewear

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0

80% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0

80% coinsurance

Deductible applies
No
Approval required
No
Referral required
No

Additional network details

These costs apply to the listed service categories and networks.

Vision benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Eye exams (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Eyewear (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Medicare-covered hearing exams

$0

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Routine hearing examsAdditional plan benefit

$0

80% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0

80% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$699.00 to $999.00 copay

Service-specific deductible
No

80% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Additional network details

These costs apply to the listed service categories and networks.

Hearing benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Hearing exams (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Prescription hearing aids (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Supplemental acupunctureAdditional plan benefit

$0

Service-specific deductible
No

$0

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Over-the-counter health itemsAdditional plan benefit

$0

Service-specific deductible
No

$0

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$150.00
How often this limit applies
Every three months
Limited-duration mealsAdditional plan benefit

$0

Service-specific deductible
No

$0

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Annual physical examAdditional plan benefit

$0

Service-specific deductible
No

$0

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0

Service-specific deductible
No

$0

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$100.00
How often this limit applies
Every three months
Approval required
Yes
Referral required
No

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Chiropractic ServicesAdditional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Routine Chiropractic CareAdditional plan benefitOut-of-network

$0

Deductible applies
No
Medicare-covered preventive servicesMedicare-covered careOut-of-network

$0

Deductible applies
No
Personal emergency alert systemAdditional plan benefitOut-of-network

$0

Deductible applies
No
Dollar benefit limit applies
Yes
Benefit allowance
$18.50
How often this limit applies
Every month
Alternative TherapiesAdditional plan benefitOut-of-network

$0

Deductible applies
No
Dollar benefit limit applies
No
Glaucoma ScreeningMedicare-covered careOut-of-network

$0

Deductible applies
No
Diabetes Self-Management TrainingMedicare-covered careOut-of-network

$0

Deductible applies
No
Digital Rectal ExamsMedicare-covered careOut-of-network

$0

Deductible applies
No
EKG after a Welcome to Medicare visitMedicare-covered careOut-of-network

$0

Deductible applies
No
Medicare Part B insulinMedicare-covered careOut-of-network

50% coinsurance

Deductible applies
No

Allowances and optional benefits

Alternative therapy

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance
Routine Chiropractic Care; Acupuncture Treatments; Alternative Therapies
How benefits are provided
Debit Card
Advance choice of benefits required
Yes
Shared benefit limit
$100.00
How often this limit applies
Every six months
Shared limit on visits or trips
No

Prescription drug coverage

This plan does not include a Part D prescription drug benefit.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.