We are moving to a NEW location on July 26, 2010: 2270 NW Aviation Dr. Suite 3
Across from Aviation Suites at Roseburg Regional Airport
Questions? or To request an Exception or Appeal Call Customer Service:
Toll-Free: 877-672-8620 TTY: 800-735-2900
Monday - Friday, 8am to 5pm PT

Frequently Asked Questions
What are the Medicare enrollment periods?
 
Initial Enrollment Period - The first opportunity to enroll in Medicare Part B that normally occurs when you reach age 65 and lasts for seven months starting three months prior to the month of your 65th birthday.
This opportunity also occurs for someone on Social Security Disability at the 25th month of disability.
 
Annual Coordinated Election Period - The period from November 15 to December 31 each year where a Medicare Advantage or a Prescription Drug Plan member may change plans freely with an effective date of January 1 of the following year.
 
General Enrollment Period - The period from January 1 through March 31 of each year, during which time you can enroll in Medicare Part B, if you didn't enroll during the Initial Enrollment Period or a Special Enrollment Period. Coverage will not start until July 1 of that same year and you may be subject to a late-enrollment penalty. The same time conditions apply to Medicare Part A, if you were not eligible to receive it automatically.
 
 
When am I eligible to enroll in an ATRIO Health Plan?
 
 You need to meet three requirements to join ATRIO Health Plans:
    1. You need to have both Medicare Part A and Medicare Part B coverage and you have to continue to pay your monthly Medicare Part B premium.
    2. You need to both reside within and receive services in ATRIO’s service area.
    3. You cannot have End-Stage Renal Disease (ESRD) unless you are already in a plan and are transferring to another plan or have had a successful kidney transplant. ESRD is permanent kidney failure that requires either dialysis or a kidney transplant.
You can join an ATRIO Health Plan when first eligible or once a year.
 
 
What is Medicare Part A and Part B?
 
  • Medicare Part A – Is Medicare provided hospital and skilled nursing facility coverage that you are usually eligible for when you turn age 65.
  • Medicare Part B – Is Medicare provided coverage for all other covered medical services. It is optional and requires payment of a monthly premium.
 
What is a Medicare Part D?
 
  • Medicare Part D enrollment involves selecting a Prescription Drug Plan (PDP) offered by a private insurance company. These prescription drug plans are offered under a policy, contract, or plan that has been approved by the government. Prescription drug coverage is offered with several ATRIO Health Plans.
 
Will my prescriptions be covered?
  •  Medicare Prescription Drug Plans must include at least two drugs in every drug category.

ATRIO will also:

    1. Make sure you have convenient access to retail pharmacies
    2. Have a process for you to get drugs that are not on the list of covered drugs (formulary) when it is medically necessary
    3. Provide useful information to you, such as how formularies and medication management programs work, information on saving money with generic drugs, and grievance and appeal processes.     
What is a Drug Formulary?
A list of prescription drugs selected by an insurance company or health plan that are considered "formulary", "preferred", or "approved" drugs. Prescription drugs are chosen based upon clinical information and price and the list is referred to as a formulary drug list.
  
What is a deductible?

A deductible is the amount, usually on a per calendar year or per benefit period basis, that you pay for medical services in a year or benefit period before the insurance company or health plan pays any claims on services subject to the deductible. After the deductible has been satisfied, the insurance company usually shares expenses with you on a pre-determined basis.

What is a Copay?

A copay is a small dollar amount due at the time of service and based on a per-visit or per occurrence   basis. A typical example would be a physician visit copay due when visiting his office.

 What do ATRIO Health Plans cover? 

ATRIO Health Plans cover everything that Original Medicare covers and more. We can be your complete health plan. For details about benefits, please call ATRIO Health Plans customer service at 1-877-672-8620.

What is a premium?
 
The premium is the monthly amount due to an insurance company or health plan to cover the cost of the policy.
 
What is a Pre-authorization?
 
A requirement by an insurance company or health plan that certain services must be approved in advance to be covered or to be covered without a penalty.
 
 
To help you get the health care you need, we ask that you build a relationship with one doctor who you feel comfortable with, a doctor you trust, a doctor who can get to know you and your health history. We call this doctor your "primary care provider." You must select a primary care provider in our network. To find out whether your current doctor is part of the ATRIO Health Plan Network, please check our Provider Network page on our website, or call ATRIO Health Plan customer service at 1-877-672-8620.
 
What happens if I need to see a doctor while out of the service area? Will ATRIO cover Emergency Room or Urgent Care visits?
 
You have the right to receive emergency care at regardless of whether you are in ATRIO’s service area or not. You will still be required to pay a co-pay for the visit.
 
 
What is a Referral?
 
You may need to get a referral from your Primary Care provider in order to see a specialist. If you wish to see a specialist outside of ATRIO’s network of providers a prior authorization may be required prior to the visit or you may be required to pay a higher fee. Some specialist services may be required without a referral or prior authorization, please call ATRIO’s customer service department or check with your Primary Care Physician with questions regarding coverage.
 
 
 
 
 
 
 
H3814_MKG 50_03
CMS Approved: 10/20/09
Date Last Updated: 09/17/2009