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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 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 Palm Beach. 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 will pay varying copays and coinsurance amounts depending on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at standard pharmacies, a $20 copay for standard generic drugs, and a $75 copay for preferred brand drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers a range of benefits, including inpatient and outpatient hospital care, with varying copays. The plan also covers primary care, preventive, hearing, vision, and dental services, along with ambulance and home health services. Many services such as preventive services, home health, and skilled nursing facilities have no copay. Additional benefits include coverage for hearing aids up to $1,500 per year, a maximum of $3,500 per year for dental services, and up to $112 per month for over-the-counter items. Emergency services have a $90 copay, and ground ambulance services have a $200 copay. However, some services like cardiac rehabilitation and certain types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you have a $50 copay for days 1-10, and no copay for days 11-90, while additional days and upgrades are not covered. For Inpatient Hospital Psychiatric, you have a $50 copay for days 1-10, and no copay for days 11-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital services have a $75 copay, and observation services have a $50 copay. Individual and group sessions for outpatient substance abuse have a copay of $40.
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 for this benefit.
Ambulance and Transportation Services See details
The Solis Healthy Living Plan (HMO) covers ambulance and transportation services. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are also covered.
Emergency Services See details
Emergency Services are covered by the Solis Healthy Living Plan (HMO), with a $90 copay and no coinsurance. Worldwide Emergency Coverage has a $120 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care services, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, are covered under the Solis Healthy Living Plan (HMO). Occupational Therapy Services have a copay between $10 and $40. Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $40. Individual and Group Sessions for Mental Health and Psychiatric Services have a $20 copay. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services, with services like in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, 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 modifications, and counseling services not covered. Additionally, Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $1,500 per year, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services with the Solis Healthy Living Plan (HMO) include coverage for routine eye exams with one visit allowed per year. Eyewear is covered with a combined maximum benefit of $250 per year, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Solis Healthy Living Plan (HMO) covers dental services, including oral exams, dental x-rays (1 every three years), other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery. The plan provides a maximum of $3,500 per year for dental services, but does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Solis Healthy Living Plan (HMO). For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Healthy Living Plan (HMO), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Solis Healthy Living Plan (HMO), including Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetic Devices with a 20% coinsurance. Some services are covered, including Durable Medical Equipment for use outside the home, Medical Supplies, and Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures with a copay between $0 and $50, and for diagnostic radiological services with a copay up to $75. Therapeutic radiological services have a copay up to $60, and outpatient X-ray services have no copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Solis Healthy Living Plan (HMO). Prior authorization and a doctor referral are required for these services, but all sub-services are listed as not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Solis Healthy Living Plan (HMO), requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $125 copay for days 21-100. Additional days beyond Medicare coverage and non-Medicare covered stays for SNF are not covered.
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 offers up to $112 per month for Over-the-Counter (OTC) items, including nicotine replacement therapy. A meal benefit is covered for chronic illnesses with a doctor's referral. However, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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