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Solis Guardian Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Guardian Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Guardian Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
Solis Guardian Plan (HMO D-SNP) is a HMO D-SNP plan offered by Athena Healthcare Holdings, LLC available for enrollment in 2025 to people living in Miami-Dade. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Solis Guardian Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Solis Guardian Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Solis Guardian Plan (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Solis Guardian Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Solis Guardian Plan (HMO D-SNP) features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 2 generics filled at standard pharmacies for up to a three-month supply, or via standard mail order for a three-month supply. Additionally, there is no copay for a one-month supply of Tier 6 supplemental drugs at standard pharmacies. For brand-name and specialty medications, the plan utilizes a coinsurance model. You will pay a 25% coinsurance for Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty tier medications when utilizing standard pharmacies. This structure allows you to easily estimate your potential out-of-pocket prescription expenses.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive coverage with no copay and no coinsurance for most primary care, specialist visits, inpatient hospital stays, and preventive services. Vision, hearing, and dental benefits are also covered with no copay or coinsurance, featuring generous allowances such as up to $5,000 for dental care and $2,000 for hearing aids. While most services cost nothing out of pocket, members will face a 20% coinsurance for dialysis and air ambulance services, as well as a potential $180 copay for partial hospitalization. This plan also provides valuable extra benefits like unlimited one-way transportation to approved health locations and a $125 monthly over-the-counter item allowance. However, certain services are excluded from coverage, including cardiac rehabilitation, ground ambulance rides, and diagnostic services like X-rays and lab tests. Additionally, many of the covered benefits require prior authorization or a referral from a provider to access.
Inpatient Hospital See details
Solis Guardian Plan (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization and referrals are required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Solis Guardian Plan (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. Outpatient substance abuse services are partially covered under the plan, though individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Solis Guardian Plan (HMO D-SNP) with either no copay or a $180 copay, and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Solis Guardian Plan (HMO D-SNP) provides ambulance and transportation services, offering air ambulance coverage with a 20% coinsurance and no copay, while ground ambulance services are not covered. Unlimited one-way transportation to plan-approved health-related locations is covered with no copay and no coinsurance, though rides to non-approved health locations are not covered.
Emergency Services See details
Solis Guardian Plan (HMO D-SNP) provides coverage for emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered with no copay or coinsurance up to a maximum benefit of $75,000, though worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Solis Guardian Plan (HMO D-SNP) covers primary care, specialist, occupational and physical therapy, speech-language pathology, telehealth, podiatry, and opioid treatment services with no copay and no coinsurance. Chiropractic services are partially covered with no copay or coinsurance for up to 12 routine visits yearly (other chiropractic services are not covered), while psychiatric and mental health specialty services are not covered.
Preventive Services See details
Preventive services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, though certain services require a referral. This benefit is partially covered, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Solis Guardian Plan (HMO D-SNP) offers hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered up to a $2,000 annual maximum with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by the Solis Guardian Plan (HMO D-SNP), featuring no copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam per year (while other eye exam services are not covered) and up to $350 annually for eyewear, including contact lenses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, up to a $5,000 annual maximum. While preventive and comprehensive treatments like cleanings, exams, and implants are covered, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Solis Guardian Plan (HMO D-SNP) partially covers Home Infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs are covered with no copay and no coinsurance, while Medicare Part B chemotherapy or radiation drugs and other Medicare Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Solis Guardian Plan (HMO D-SNP) covers Durable Medical Equipment (DME) with no copay and no coinsurance, subject to prior authorization. For diabetic equipment and non-Medicare prosthetics, some services are covered with no copay and no coinsurance, but prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, though only some services are covered. Specifically, diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Home Health Services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, though both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Solis Guardian Plan (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as none of the individual sub-services are covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required. While the plan allows for admission without a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Solis Guardian Plan (HMO D-SNP) provides partially covered other services, which include a $125 monthly over-the-counter (OTC) item allowance and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, naloxone, and highly integrated services are not covered, and a referral is required to access the meal benefit.
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