2023 ATRIO Prime Rx (PPO)

ATRIO Prime Rx (PPO) H6743-023 is a 2023 Medicare Advantage Plan or Part-C by ATRIO Health Plans available to residents in Oregon. This plan includes extra prescription drug (Part-D) coverage. ATRIO Health Plans ATRIO Prime Rx (PPO) has a monthly premium of $99.00 and has an in-network maximum out-of-pocket limit of $2,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $2,500 out-of-pocket. This can be an extremely nice safety net.

ATRIO Health Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for ATRIO Prime Rx (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from ATRIO Health Plans and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from ATRIO Health Plans except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Oregon.

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Benefits
Monthly Costs
Formulary and Drugs
Gap coverage
Premium Assistance
MOOP
Reviews
Coverage Area

2023 ATRIO Health Plans Medicare Advantage Plan Overview

Name:	ATRIO Prime Rx (PPO)
Plan ID:	H6743 023 1
Provider:	ATRIO Health Plans
Year:	2023
Type:	Local PPO
Combined Premium (C+D):	$99.00/mo
Part C Premium:	$45.50/mo
MOOP:	$2,500/yr
Part D (Drug) Premium:	$53.50/mo
Part D Supplemental Premium	$0/mo
Total Part D Premium:	$53.50/mo
Drug Deductible:	$0/yr
Tiers with No Deductible:	0
Gap Coverage:	No
Benchmark:	Not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H6743-024

What type of plan is ATRIO Prime Rx (PPO)

ATRIO Prime Rx (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does ATRIO Prime Rx (PPO) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. ATRIO Health Plans charges a $99.00 consolidated premium. The Part C premium is $45.50 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. ATRIO Prime Rx (PPO) has a monthly drug premium of $53.50 and a $0 drug deductible. This ATRIO Health Plans plan offers a $53.50 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by ATRIO Health Plans above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $53.50. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

ATRIO Health Plans Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers extra coverage. This ATRIO Health Plans plan does not offer extra coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The ATRIO Prime Rx (PPO) medicare insurance offers a $12.50 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $22.70 for 75% low-income subsidy $33.00 for 50% and $43.20 for 25%.

Full Assistance Premium:	$12.50
75% Assistance Premium:	$22.70
50% Assistance Premium:	$33.00
25% Assistance Premium:	$43.20

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. ATRIO Prime Rx (PPO) by ATRIO Health Plans MOOP is $2,500. Once you spend $2,500 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

Formulary and Drug Coverage

ATRIO Prime Rx (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$8
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	33%
Tier 6	NA	$0

The complete ATRIO Prime Rx (PPO) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what ATRIO Prime Rx (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from ATRIO Health Plans helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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

Contact lenses

In-Network Vision	$0 copay
Out-of-Network Vision	0-50% coinsurance

Eyeglass frames

Vision	Not covered

Eyeglass lenses

Vision	Not covered

Eyeglasses (frames and lenses)

Out-of-Network Vision	0-50% coinsurance
In-Network Vision	$0 copay

Other

Vision	Not covered

Routine eye exam

In-Network Vision	$0 copay
Out-of-Network Vision	0-50% coinsurance

Upgrades

In-Network Vision	$0 copay
Out-of-Network Vision	0-50% coinsurance

In-Network Transportation	$0 copay
Out-of-Network Transportation	$0 copay
Out-of-Network Skilled Nursing Facility	$125 per day for days 1 through 100
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $125 per day for days 21 through 100

Occupational therapy visit

Out-of-Network Rehabilitation services	50% coinsurance
In-Network Rehabilitation services	$30 copay

Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$30 copay
Out-of-Network Rehabilitation services	50% coinsurance

Cleaning

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

Dental x-ray(s)

Out-of-Network Preventive dental	$0 copay
In-Network Preventive dental	$0 copay

Fluoride treatment

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

Out-of-Network Preventive care	$0 copay
In-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$275 copay per visit
Out-of-Network Outpatient hospital coverage	$325 copay per visit
Out-of-Network Outpatient hospital coverage	$375 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

Inpatient hospital - psychiatric

In-Network Mental health services	$200 per day for days 1 through 8 $0 per day for days 9 through 90
Out-of-Network Mental health services	$325 per day for days 1 through 7 $0 per day for days 8 through 90
Out-of-Network Mental health services	$325 per day for days 1 through 8 $0 per day for days 9 through 90

Outpatient group therapy visit

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	50% coinsurance

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	50% coinsurance

Outpatient individual therapy visit

Out-of-Network Mental health services	50% coinsurance
In-Network Mental health services	$25 copay

Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	50% coinsurance
In-Network Mental health services	$25 copay

Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	50% coinsurance

Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	50% coinsurance

Diabetes supplies

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	20% coinsurance per item

Durable medical equipment (e.g., wheelchairs, oxygen)

Out-of-Network Medical equipment/supplies	25% coinsurance per item
Out-of-Network Medical equipment/supplies	30% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	25% coinsurance per item
Out-of-Network Medical equipment/supplies	30% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$5,450 In and Out-of-network $3,500 In-network
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$5,000 In and Out-of-network $2,500 In-network
In-Network Inpatient hospital coverage	$225 per day for days 1 through 8 $0 per day for days 9 through 90
Out-of-Network Inpatient hospital coverage	$350 per day for days 1 through 7 $0 per day for days 8 through 90
Out-of-Network Inpatient hospital coverage	$350 per day for days 1 through 8 $0 per day for days 9 through 90

Fitting/evaluation

In-Network Hearing	$0 copay
Out-of-Network Hearing	$0 copay

Hearing aids

In-Network Hearing	$699-999 copay
Out-of-Network Hearing	$699-999 copay

Hearing exam

In-Network Hearing	$25 copay
Out-of-Network Hearing	$50 copay
In-Network Hearing	$15 copay

Health plan deductible	$0
Out-of-Network Ground ambulance	$225 copay
In-Network Ground ambulance	$225 copay

Foot exams and treatment

Out-of-Network Foot care (podiatry services)	50% coinsurance
In-Network Foot care (podiatry services)	$25 copay

Routine foot care

Foot care (podiatry services)	Not covered

Emergency

Emergency care/Urgent care	$125 copay per visit (always covered)
Emergency care/Urgent care	$110 copay per visit (always covered)

Urgent care

Emergency care/Urgent care	$25 copay per visit (always covered)

Primary

In-Network Doctor visits	$0 copay
In-Network Doctor visits	$10 copay per visit
Out-of-Network Doctor visits	$30 copay per visit

Specialist

In-Network Doctor visits	$25 copay per visit
Out-of-Network Doctor visits	$50 copay per visit

Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$100 copay
In-Network Diagnostic procedures/lab services/imaging	20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$10 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$15 copay

Lab services

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay

Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$15 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$15 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

Diagnostic services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

Endodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

Extractions

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

Non-routine services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

Periodontics

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

Restorative services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

ATRIO Prime Rx (PPO) Reviews

Is ATRIO Prime Rx (PPO) a good plan? ATRIO Prime Rx (PPO) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare ATRIO Prime Rx Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with H6743-023 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for ATRIO Health Plans

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for ATRIO Prime Rx (PPO) requires you to live in that plan’s service area. The service area is listed below:

State:	Oregon Medicare
County:	Douglas County MA Plans Jackson County MA Plans Josephine County MA Plans Klamath County MA Plans

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How much does ATRIO Prime Rx (PPO) cost?

ATRIO Health Plans charges a $99.00 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is ATRIO Prime Rx (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. ATRIO Prime Rx (PPO) by ATRIO Health Plans MOOP is $2,500. Once you spend $2,500 you will pay nothing for Part A or Part B covered services.

What type of plan is ATRIO Prime Rx (PPO)?

ATRIO Prime Rx (PPO) is a Local PPO. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is ATRIO Prime Rx (PPO) a good plan?

ATRIO Prime Rx (PPO) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.

Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.