A non-government entity
Solis Healthy Living Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Healthy Living Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Healthy Living Plan (HMO) in 2025, please refer to our full plan details page.
Solis Healthy Living Plan (HMO) is a HMO plan offered by Athena Healthcare Holdings, LLC available for enrollment in 2025 to people living in Broward. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Solis Healthy Living Plan (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Solis Healthy Living Plan (HMO).
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 Healthy Living Plan (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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 Healthy Living Plan (HMO) has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $15 copay, preferred brand drugs have a $70 copay, and non-preferred drugs have 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Solis Healthy Living Plan (HMO) provides comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. It also offers benefits for primary care, hearing, vision, and dental services, with specific limits and copays for each. Additional benefits include coverage for ambulance, emergency services, and home health services with no copays, as well as coverage for medical equipment and home infusion services.
Inpatient Hospital See details
The Solis Healthy Living Plan (HMO) covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered. The plan also offers one additional day for Inpatient Hospital-Acute stays.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $50 copay, while individual and group sessions for outpatient substance abuse have a $30 copay; outpatient blood services include a waived deductible of three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Healthy Living Plan (HMO), with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
The Solis Healthy Living Plan (HMO) covers ambulance and transportation services. Ground ambulance services have a $75 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Solis Healthy Living Plan (HMO) with a $75 copay, and no coinsurance. Worldwide Emergency Coverage is covered with a $75 copay, and no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Healthy Living Plan (HMO) covers primary care physician services, chiropractic services, occupational therapy services with a copay between $5 and $25, physician specialist services, mental health specialty services with a $20 copay for individual and group sessions, podiatry services, other health care professional services, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a copay between $5 and $25, additional telehealth benefits, and opioid treatment program services with a $30 copay. A doctor referral is required for many of these services.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and additional preventive services. This plan also covers health education, nutritional/dietary benefits, in-home support services, additional smoking cessation sessions, fitness benefits, remote access technologies, kidney disease education, and other preventive services like glaucoma screenings and diabetes self-management training. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types), with no copay or coinsurance. However, prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one visit allowed every year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $250.00 every year.
Dental Services See details
The Solis Healthy Living Plan (HMO) offers dental services with a maximum benefit of $3,500 per year. Oral exams, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery are covered. Dental X-rays are limited to one every three years, restorative services are limited to one every five years, periodontics are limited to one every two years, prosthodontics (removable) are limited to one every five years, implant services are limited to one every 10 years, and prosthodontics (fixed) are limited to one every five years. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Healthy Living Plan (HMO) and require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Solis Healthy Living Plan (HMO), with Durable Medical Equipment (DME) subject to a 0-20% coinsurance and requiring prior authorization, though DME for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has no copay, and is subject to a coinsurance, while Prosthetic Devices are covered with a 20% coinsurance. Diabetic Equipment includes Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $25, while Diagnostic Radiological Services have a maximum copay of $75, and Therapeutic Radiological Services have a maximum copay of $25; Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but all of the sub-services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Solis Healthy Living Plan (HMO). There is no copay for days 1-20, and a $50 copay for days 21-100.
Other Services See details
The Solis Healthy Living Plan (HMO) covers acupuncture with a limit of 24 treatments per year, and requires prior authorization. The plan also covers over-the-counter (OTC) items up to $110.00 per month, and offers a meal benefit with a doctor's referral. However, some services, such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others, are not covered.
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