Go Back

ATRIO Select Rx (PPO)

H7006 - 015 - 0
3 out of 5 stars (3 / 5)

ATRIO Select Rx (PPO) is a Medicare Advantage Plan by ATRIO Health Plans.

This page features plan details for 2025 ATRIO Select Rx (PPO) H7006 – 015 – 0.

IMPORTANT: This page features the 2025 version of this plan. See the 2025 version using the link below:

2025 ATRIO Select Rx (PPO) H7006 - 015 - 0

Locations

ATRIO Select Rx (PPO) is offered in the following locations.

Carson City County, Nevada
Churchill County, Nevada
Douglas County, Nevada

Click to see more locations

Plan Overview

ATRIO Select Rx (PPO) offers the following coverage and cost-sharing.

Insurer:ATRIO Health Plans
Health Plan Deductible:$0
MOOP:$6,200 In and Out-of-network
$4,150 In-network
Drugs Covered:Yes

Ready to sign up for ATRIO Select Rx (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

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

ATRIO Select Rx (PPO) qualifies for a monthly Medicare Give Back Benefit of $20.00.

Premium Reduction:$20.00

Premium Breakdown

ATRIO Select Rx (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $20.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

ATRIO Select Rx (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

ATRIO Select Rx (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Orthodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – No Copay (Limits Apply, Authorization Required)
  • Fluoride Treatment
    • In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – No Copay (Limits Apply, Authorization Required)
  • Oral Exams
    • In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – No Copay (Limits Apply, Authorization Required)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – No Copay (Limits Apply, Authorization Required)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – No Copay (Limits Apply, Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – No Copay (Limits Apply, Authorization Required)

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-60 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)

Doctor visits

  • Primary
    • Out-of-Network: $50 copay per visit
  • Specialist
    • In-Network: $25 copay per visit
    • Out-of-Network: $50 copay per visit
  • Primary
    • In-Network: $0 copay

Emergency care/Urgent care

  • Urgent care
    • $30 copay per visit (always covered)
  • Emergency
    • $140 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: 50% coinsurance
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • In-Network: $5 copay

Ground ambulance

    • In-Network: $300 copay
    • Out-of-Network: $300 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay (Authorization Required)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Medicare-Covered Hearing Exam
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Fitting/evaluation
    • Out-of-Network: $0 copay (Authorization Required)
  • Hearing aids OTC
    • Not covered
  • Hearing aids
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)

Inpatient hospital coverage

    • In-Network: Tier 1
      $0 copay per stay
      Tier 2
      $300 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 50% per stay (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $6,200 In and Out-of-network
      $4,150 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $10 copay
  • Inpatient hospital – psychiatric
    • Out-of-Network: 50% per stay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $10 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance
  • Outpatient individual therapy visit
    • In-Network: $10 copay
  • Inpatient hospital – psychiatric
    • In-Network: $300 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: 50% coinsurance
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $10 copay
  • Outpatient individual therapy visit
    • Out-of-Network: 50% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-350 copay per visit (Authorization Required)
    • Out-of-Network: 50% coinsurance per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $0 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $0 copay (Authorization Required)

Skilled Nursing Facility

    • In-Network: $20 per day for days 1 through 20
      $170 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 50% per stay (Authorization Required)

Transportation

    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Vision

  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Not covered
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for ATRIO Select Rx (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

For the 2025 version of ATRIO Select Rx (PPO)? see 2025 ATRIO Select Rx (PPO) at MedicareAdvantageRX.com.

Table of Contents