2027 Medicare Advantage plan
ATRIO Special Needs Plan (HMO D-SNP): 2027 benefits and costs
ATRIO Health Plans HMO D-SNP Special Needs Plan
CMS plan ID: H3814-007-0 · Plan year: 2027
ATRIO Special Needs Plan (HMO D-SNP) is a 2027 Medicare Advantage plan offered by ATRIO Health Plans. It is listed in Oregon.
2027 plan costs at a glance
Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.
- Organization
- ATRIO Health Plans
- Plan organization
- ATRIO HEALTH PLANS
- Parent company
- ATRIO Health Plans
- Plan type
- HMO D-SNP
- Part C premium
- $0.00
- Part D premium
- $0.00
- Prescription drug coverage
- Yes
- Special Needs Plan type
- Dual-Eligible
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- In-network medical deductible
- Same as Medicare's Part B deductible
Applies to in-network Medicare-covered services.
- In-network medical maximum
- $9,850.00
Who can join this Special Needs Plan?
This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.
- Plan eligibility type
- Dual-Eligible
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | What to know |
|---|---|---|
| Primary care doctor | 20% coinsurance
| |
| Specialist visit | 20% coinsurance
|
|
| Telehealth | 20% coinsurance
|
|
| Emergency care | $115.00 copay | |
| Urgent care | 20% coinsurance | |
| Home health | $0
|
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| Dialysis | 20% coinsurance
|
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| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
|
|
| Kidney disease education services | 20% coinsurance
|
|
| Medicare-covered chiropractic | 20% coinsurance
|
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| Medicare-covered foot care | 20% coinsurance
|
|
| Other health professionals | 0% to 20% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay |
|
| Inpatient hospital stay | 0% coinsurance per stay Days 1–6: 7% coinsurance per day Days 7–10: 8% coinsurance per day Days 11–90: 20% coinsurance per day |
|
| Inpatient mental health care | $0.00 copay per stay |
|
| Inpatient mental health care | 14% coinsurance per stay |
|
| Skilled nursing facility | Days 1–20: 0% coinsurance per day Days 21–100: 10% coinsurance per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | What to know |
|---|---|---|
| Outpatient hospital care | 20% coinsurance
| |
| Hospital observation services | 20% coinsurance
| |
| Ambulatory surgical center | 20% coinsurance
|
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| Outpatient blood | 20% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | What to know |
|---|---|---|
| Diagnostic procedures and tests | 20% coinsurance
|
|
| Laboratory services | 20% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | 20% coinsurance
|
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| Therapeutic radiology | 20% coinsurance
|
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| X-rays | 20% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | What to know |
|---|---|---|
| Partial hospitalization | 20% coinsurance
|
|
| Intensive outpatient program | $55.00 copay
|
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| Substance use treatment, individual sessions | 20% coinsurance
|
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| Substance use treatment, group sessions | 20% coinsurance
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| Opioid treatment program | 20% coinsurance
|
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| Mental health, individual sessions | 20% coinsurance
|
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| Mental health, group sessions | 20% coinsurance
|
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| Psychiatry, individual sessions | 20% coinsurance
|
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| Psychiatry, group sessions | 20% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | What to know |
|---|---|---|
| Occupational therapy | 20% coinsurance
|
|
| Physical and speech therapy | 20% coinsurance
|
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| Cardiac rehabilitation | 20% coinsurance
|
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| Intensive cardiac rehabilitation | 20% coinsurance
|
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| Pulmonary rehabilitation | 20% coinsurance
|
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| Supervised exercise for peripheral artery disease | 20% coinsurance
|
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Ambulance, medical equipment and supplies
| Service | In-network | What to know |
|---|---|---|
| Ground ambulance | 20% coinsurance
|
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| Air ambulance | 20% coinsurance
|
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| Durable medical equipment | 20% coinsurance
|
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| Prosthetic devices | 20% coinsurance
|
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| Medical supplies | 20% coinsurance
|
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| Diabetic supplies | $0
|
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| Diabetic shoes and inserts | $0
|
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| Diabetic monitors | $0
|
|
Dental benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered dental | 20% coinsurance | |
| Oral examsAdditional plan benefit | $0 | |
| Dental X-raysAdditional plan benefit | $0 | |
| Other diagnostic dentalAdditional plan benefit | $0 | |
| Dental cleaningAdditional plan benefit | $0 | |
| FluorideAdditional plan benefit | $0 | |
| Other preventive dentalAdditional plan benefit | $0 | |
| Restorative dental careAdditional plan benefit | $0 | |
| Root canal treatment (endodontics)Additional plan benefit | $0 | |
| Gum treatment (periodontics)Additional plan benefit | $0 | |
| Removable dentures (prosthodontics)Additional plan benefit | $0 | |
| Maxillofacial prostheticsAdditional plan benefit | $0 | |
| Dental implantsAdditional plan benefit | $0 | |
| Fixed dental restorations (prosthodontics)Additional plan benefit | $0 | |
| Oral surgeryAdditional plan benefit | $0 | |
| OrthodonticsAdditional plan benefit | $0 | |
| Other dental servicesAdditional plan benefit | $0 |
Vision benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered eye exams | 20% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0 |
|
| Medicare-covered eyewear | $0
|
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| Contact lensesAdditional plan benefit | $0 |
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| Eyeglasses, lenses and framesAdditional plan benefit | $0 |
|
Hearing benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered hearing exams | 20% coinsurance
|
|
Extra benefits
| Service | In-network | What to know |
|---|---|---|
| Supplemental acupunctureAdditional plan benefit | $0
|
|
| Over-the-counter health itemsAdditional plan benefit | $0
| |
| Limited-duration mealsAdditional plan benefit | $0
|
|
| Fitness benefitAdditional plan benefit | $0
|
|
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; Reimbursement
- Advance choice of benefits required
- No
- Shared benefit limit
- $300.00
- How often this limit applies
- Every six months
- Shared limit on visits or trips
- No
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2; Tier 6 are exempt from the deductible.
Standard retail costs
| Drug tier | 31 days | 100 days |
|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 |
| Tier 2Generic | $10.00 | $20.00 |
| Tier 3Preferred Brand | $47.00 | $94.00 |
| Tier 4Non-Preferred Drug | $100.00 | $200.00 |
| Tier 5Specialty Tier | 28% | Not listed |
| Tier 6Select Care Drugs | $0.00 | $0.00 |
Mail-order and other pharmacies
Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.
Standard mail order costs
| Drug tier | 100 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $20.00 |
| Tier 3Preferred Brand | $94.00 |
| Tier 4Non-Preferred Drug | $200.00 |
| Tier 6Select Care Drugs | $0.00 |
Long-term care pharmacy costs
| Drug tier | 34 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $10.00 |
| Tier 3Preferred Brand | $47.00 |
| Tier 4Non-Preferred Drug | $100.00 |
| Tier 5Specialty Tier | 28% |
| Tier 6Select Care Drugs | $0.00 |
Out-of-network pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $10.00 |
| Tier 3Preferred Brand | $47.00 |
| Tier 4Non-Preferred Drug | $100.00 |
| Tier 5Specialty Tier | 28% |
| Tier 6Select Care Drugs | $0.00 |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Both Part D and Excluded Drugs
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
Tier 6: Select Care Drugs
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
- Initial-coverage prices also apply to drugs exempt from the deductible
- Yes
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.