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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 Palm Beach. 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:
Sign up for Solis Healthy Living Plan (HMO)
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Drug Coverage
The Solis Healthy Living Plan (HMO) features a $0 drug deductible, allowing your prescription coverage to begin immediately. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs at standard pharmacies, as well as for 3-month standard mail orders. Additionally, Tier 6 (Supplemental Drugs) are available with no copay for a 1-month supply at standard pharmacies. For brand-name and higher-tier medications, the plan uses a structured copay or coinsurance system at standard pharmacies. Tier 3 (Preferred Brand) drugs require a copay of $20 for a 1-month supply, $40 for a 2-month supply, and $55 for a 3-month supply. Tier 4 (Non-Preferred) drugs carry a $75 copay for a 1-month supply, while Tier 5 (Specialty) drugs require a 33% coinsurance.
Additional Benefits
The Solis Healthy Living Plan (HMO) features robust coverage with no copays or coinsurance for primary care, specialist visits, routine preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $50 daily copay for the first 10 days, followed by no copay for days 11 through 90. Outpatient hospital services require a $75 copay, while emergency room visits carry a $90 copay and urgent care services require no copay. This plan also offers valuable supplemental benefits to minimize out-of-pocket costs, including dental care up to a $3,500 annual limit with no copay. Members benefit from no copays for routine vision and hearing exams, alongside annual allowances of $250 for eyewear and $1,500 for prescription hearing aids. Additionally, the plan provides up to 24 one-way transportation trips per year and a $115 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Solis Healthy Living Plan (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 daily copay for days 1 to 10 and no copay for days 11 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and both prior authorization and referrals are required.
Outpatient Services See details
Solis Healthy Living Plan (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a $75 copay and no coinsurance, observation services require a $50 copay per stay and no coinsurance, and outpatient substance abuse sessions carry a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Solis Healthy Living Plan (HMO) with a copay of either $55.00 or $180.00 and no coinsurance. Both prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Solis Healthy Living Plan (HMO) covers ground ambulance services with a $200 copay and air ambulance services with a 20% coinsurance, with the copay waived if admitted. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Solis Healthy Living Plan (HMO) with a $90 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum with a $90 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Healthy Living Plan (HMO) features no copay and no coinsurance for primary care, specialist visits, podiatry, and telehealth services. Therapy, mental health, and opioid treatment services are covered with copays ranging from $0 to $40 and no coinsurance, while chiropractic care is partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, though referrals are required for certain screenings. This benefit is partially covered, as it excludes services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing Services under the Solis Healthy Living Plan (HMO) are partially covered, offering routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to $1,500 annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by the Solis Healthy Living Plan (HMO), offering no copay, no coinsurance, and no deductible for covered benefits. The plan includes one routine eye exam per year and up to $250 annually for eyewear like contacts and eyeglasses, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance up to a $3,500 annual maximum. Non-covered services include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Solis Healthy Living Plan (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Solis Healthy Living Plan (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by the Solis Healthy Living Plan (HMO) with no copay, though prior authorization is required. Covered benefits include durable medical equipment, which ranges from no coinsurance to 20% coinsurance, and prosthetic devices and diabetic therapeutic shoes or inserts with 20% coinsurance, while medical supplies and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the Solis Healthy Living Plan (HMO), as lab services are not covered. Covered diagnostic procedures require no coinsurance and a copay of $0 to $50, while outpatient X-rays and diagnostic radiology have no copay, and therapeutic radiology carries a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Solis Healthy Living Plan (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Solis Healthy Living Plan (HMO) partially covers Cardiac Rehabilitation Services with no coinsurance, requiring a $25 copay for both cardiac and intensive cardiac rehabilitation, and a $20 copay for pulmonary rehabilitation. Supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) is not covered, and prior authorization and referrals are required for all covered services.
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 $125 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Solis Healthy Living Plan (HMO) partially covers other services, offering a meal benefit for chronic illness and up to $115 monthly for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this plan.
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