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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 2026, 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 3.5 out of 5 stars in 2026.
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) features a $0 prescription drug deductible, allowing your coverage to begin immediately. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs at standard pharmacies for up to a three-month supply, or for a three-month standard mail order. Tier 6 supplemental drugs also feature no copay for a one-month supply at standard pharmacies. For higher-tier medications, costs vary by drug class and supply duration. Tier 3 preferred brand drugs require standard pharmacy copays of $15 for one month, $30 for two months, and $40 for three months. Tier 4 non-preferred drugs require a $70 copay for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Solis Healthy Living Plan (HMO) provides comprehensive healthcare coverage with no copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and preventive services. Outpatient hospital services require a $50 copay, while emergency care has a $90 copay that is waived if you are admitted. For specialized treatments, members pay no coinsurance, with copays ranging from $5 to $40 for therapies and no copay for the first 20 days of skilled nursing facility stays. This plan also features robust supplemental benefits, including dental care up to $3,500 annually, vision services with a $250 eyewear allowance, and hearing aids up to $1,500, all with no copays or coinsurance. Additionally, members can access up to 24 one-way transportation trips per year and a $115 monthly over-the-counter item allowance at no cost. While home health services require no copay, certain medical equipment, dialysis, and Part B drugs may require coinsurance up to 20 percent.
Inpatient Hospital See details
Solis Healthy Living Plan (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. While acute care includes one additional day per benefit period, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Solis Healthy Living Plan (HMO) covers outpatient services with no coinsurance, requiring a $50 copay for outpatient hospital and observation services and a $40 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though referrals and prior authorizations are generally required.
Partial Hospitalization See details
Solis Healthy Living Plan (HMO) covers partial hospitalization benefits with a copay of either $55.00 or $180.00 and no coinsurance. These covered services require both prior authorization and a referral.
Ambulance and Transportation Services See details
Solis Healthy Living Plan (HMO) covers ground ambulance services with a $75 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Solis Healthy Living Plan (HMO) with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services have no copay or coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum with a $90 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Healthy Living Plan (HMO) covers primary care, specialist visits, telehealth, and routine podiatry with no copay and no coinsurance, though referrals are required for most specialty services. Physical, occupational, mental health, and opioid treatment therapies are covered with no coinsurance and copays ranging from $5.00 to $40.00, while chiropractic care is partially covered with 12 routine visits allowed per year at no copay or coinsurance.
Preventive Services See details
Preventive services are partially covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, though select services require a referral. Not covered sub-services include in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking and tobacco cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Solis Healthy Living Plan (HMO) offers hearing services with no copay and no coinsurance, covering one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual maximum, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Solis Healthy Living Plan (HMO) provides partially covered vision services with no copays, deductibles, or coinsurance, including one routine eye exam per year and a $250 annual allowance for eyewear. Other eye exam services are not covered, and referrals or prior authorizations are required for these benefits.
Dental Services See details
Solis Healthy Living Plan (HMO) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $3,500. While most preventive, comprehensive, and Medicare-covered dental services are fully covered, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Solis Healthy Living Plan (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Healthy Living Plan (HMO) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these services.
Medical Equipment See details
Solis Healthy Living Plan (HMO) provides partial coverage for medical equipment with no copays, although prior authorization is required. Durable medical equipment ranges from no coinsurance to 20% coinsurance, and prosthetic devices and diabetic therapeutic shoes have a 20% coinsurance, but medical supplies and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Solis Healthy Living Plan (HMO) partially covers diagnostic and radiological services, though lab services are not covered. Diagnostic tests require no coinsurance and a copay of $0 to $25, while radiological services feature no copay for X-rays and diagnostic radiology, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
The Solis Healthy Living Plan (HMO) covers Home Health Services with no copay and no coinsurance. Members will need to obtain both a referral and prior authorization to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Solis Healthy Living Plan (HMO) with no coinsurance; however, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Solis Healthy Living Plan (HMO) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $50 copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Solis Healthy Living Plan (HMO) offers partial coverage for other services, including over-the-counter (OTC) items up to $115 monthly and meal benefits for chronic illnesses, both with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires a referral.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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