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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 Hillsborough, Pasco, Pinellas. 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 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications for one, two, or three-month supplies at standard pharmacies, as well as for three-month standard mail orders. Additionally, Tier 6 supplemental drugs are available with no copay for a one-month supply at standard pharmacies. For higher-tier medications, the plan utilizes a mix of copayments and coinsurance at standard pharmacies. Tier 3 preferred brand drugs require a copay of $25 for a one-month supply, $50 for a two-month supply, and $70 for a three-month supply, while Tier 4 non-preferred drugs carry a $75 copay for a one-month supply. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers affordable healthcare coverage with no copays or coinsurance for primary care, specialist visits, and telehealth. For inpatient hospital stays, members pay a $50 copay for days 1 through 7 and no copay for days 8 through 90, with no coinsurance required. Emergency room visits require a $100 copay, which is waived if admitted within 24 hours, while urgent care services are available with no copay. In addition to medical care, the plan features extensive dental, vision, and hearing benefits with no copays or coinsurance, including a $3,000 annual dental maximum and a $250 eyewear allowance. Members also receive valuable extras such as a $115 monthly over-the-counter allowance, a chronic illness meal benefit, and up to 24 free one-way trips to approved locations. Skilled nursing facility stays are also covered with no copay for the first 20 days.
Inpatient Hospital See details
Solis Healthy Living Plan (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered because upgrades and non-Medicare-covered stays are not covered, and both referrals and prior authorizations are required.
Outpatient Services See details
Solis Healthy Living Plan (HMO) covers outpatient hospital services with an $85 copay and no coinsurance, and observation services with a $50 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Solis Healthy Living Plan (HMO) covers partial hospitalization services with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization and a referral are required for coverage of these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Solis Healthy Living Plan (HMO), requiring a $200 copay and no coinsurance for ground ambulance services, and a 20% coinsurance and a copay (waived if admitted) for air ambulance services. The plan also offers up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though transport to other health-related locations is not covered.
Emergency Services See details
Solis Healthy Living Plan (HMO) covers emergency services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum limit with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Healthy Living Plan (HMO) provides primary care, specialist visits, podiatry, and telehealth with no copays or coinsurance, while routine chiropractic care is covered up to 12 visits per year with no copay or coinsurance (other chiropractic services are not covered). Therapy services require a $10 to $40 copay, mental health and psychiatric services have a $20 copay, and opioid treatment has a $40 copay, all with no coinsurance and varying referral or prior authorization requirements.
Preventive Services See details
Preventive services are covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, although referrals are required for certain services like glaucoma screenings and diabetes self-management training. This benefit is partially covered, as additional services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Solis Healthy Living Plan (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are also covered with no copay or coinsurance up to a $1,000 annual limit, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Solis Healthy Living Plan (HMO) offers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam per year and a $250 annual allowance for eyewear. While contacts and eyeglasses are covered, other eye exam services are not covered, and referrals or prior authorizations may be required.
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 $3,000. While many preventive and comprehensive services are 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 and no coinsurance, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
The Solis Healthy Living Plan (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Solis Healthy Living Plan (HMO) partially covers medical equipment with prior authorization required and no copays for covered items. Durable medical equipment incurs no coinsurance to 20% coinsurance, and prosthetic devices and diabetic therapeutic shoes carry a 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) because lab services are not covered. Covered diagnostic tests require a referral and have no coinsurance with copays ranging from no copay to $90, while radiological services require referrals and prior authorization, featuring no copays for x-rays and diagnostic radiology alongside a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered under the Solis Healthy Living Plan (HMO) with no copay and no coinsurance. Access to these services requires both a referral and prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Solis Healthy Living Plan (HMO) with no coinsurance, but require prior authorization and referrals. While some services are covered, cardiac rehabilitation (which carries a $25 copay), intensive cardiac rehabilitation (with a $25 copay), pulmonary rehabilitation (with a $20 copay), and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Solis Healthy Living Plan (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $150 copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Solis Healthy Living Plan (HMO) offers partially covered other services with no copay and no coinsurance, including a chronic illness meal benefit and a $115 monthly over-the-counter allowance. However, acupuncture, naloxone, and other additional services are not covered under this benefit.
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