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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 Hillsborough, Pasco, Pinellas. 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 $2500.00 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. During the initial coverage phase, you will pay different copays depending on the drug tier. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, $15 for standard generic drugs, and $75 for preferred brand drugs. In the initial coverage phase, non-preferred drugs have a 33% coinsurance, while specialty tier drugs have a $0 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. The plan also provides benefits for primary care, preventive services, hearing, vision, and dental care, with specific limitations on certain services. Additionally, this plan offers extra benefits such as transportation, ambulance services, and over-the-counter items. This plan includes coverage for services such as ambulance, emergency, and partial hospitalization, with copays ranging from $50 to $200. It also covers home infusion and dialysis services with copays or coinsurance depending on the service. The plan also includes benefits for skilled nursing facilities, home health, and other services like acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Solis Healthy Living Plan (HMO), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5, there is a $30 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Solis Healthy Living Plan (HMO). Outpatient Hospital Services have a $85 copay, while Observation Services have a $50 copay. Outpatient Substance Abuse services, including both individual and group sessions, are covered with a copay of $40 per session. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Healthy Living Plan (HMO), requiring prior authorization and a doctor's referral. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Solis Healthy Living Plan (HMO). Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Solis Healthy Living Plan (HMO), with a $100 copay for both Emergency Services and Worldwide Emergency Coverage, and no copay for Urgently Needed Services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Healthy Living Plan (HMO) covers Primary Care benefits, 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. Occupational Therapy Services have a copay between $10 and $40, and Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $40. For Individual and Group Sessions for Mental Health and Psychiatric Services, there is a $20 copay. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar services, an annual physical exam, and additional preventive services. This plan also covers health education, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, in-home safety assessment, personal emergency response system, medical nutrition therapy, 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 are not covered.
Hearing Services See details
Hearing services with the Solis Healthy Living Plan (HMO) cover hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum plan benefit of $1000 every year; however, prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, as well as coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $250 per year. A doctor referral is required for eye exams and eyewear.
Dental Services See details
The Solis Healthy Living Plan (HMO) offers a dental services benefit with a maximum plan benefit of $3,000 per year. Oral exams, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, and Oral and Maxillofacial Surgery are covered, while Dental X-Rays are limited to one every three years, Restorative Services, Periodontics, Prosthodontics, removable, Implant Services, and Prosthodontics, fixed are limited to one visit, and 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 coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance is 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). Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Durable Medical Equipment for use outside the home, Medical Supplies, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for diagnostic procedures and tests with a copay between $0 and $90, and diagnostic radiological services with a copay of up to $90. Therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have no copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered under 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 not covered by the Solis Healthy Living Plan (HMO). Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Solis Healthy Living Plan (HMO). For days 1-20, there is no copay, and for days 21-100, the copay is $150.
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 offers over-the-counter (OTC) items, with a maximum benefit of $109.00 per month, including nicotine replacement therapy, but does not cover Naloxone. Additionally, the plan covers a meal benefit for chronic illnesses with a doctor referral. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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