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Solis Guardian Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Guardian Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Guardian Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
Solis Guardian Plan (HMO D-SNP) is a HMO D-SNP 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 Guardian Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Solis Guardian Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Solis Guardian Plan (HMO D-SNP).
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 Guardian Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 Guardian Plan (HMO D-SNP) prescription drug coverage features an annual drug deductible of $615. Beneficiaries enjoy 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 three-month standard mail-order refills. Additionally, Tier 6 (Supplemental Drugs) are available with no copay for a one-month supply at standard pharmacies. For brand-name and specialty medications, the plan transitions to a coinsurance model at standard pharmacies. You will pay a 25% coinsurance for Tier 3 (Preferred Brand) drugs across all supply durations, and a 25% coinsurance for a one-month supply of Tier 4 (Non-Preferred) and Tier 5 (Specialty Tier) drugs. This combination of no-copay generics and percentage-based coinsurance defines the initial coverage phase for this Medicare plan.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive medical coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary care, specialist visits, and home health care. Many outpatient, preventive, and emergency services are also available with no copay and no coinsurance, though prior authorization or referrals are required for some benefits. However, members should expect a 20% coinsurance with no copay for dialysis and air ambulance services, while ground ambulance services are not covered under this plan. This plan also features robust supplemental benefits at no copay or coinsurance, including up to $4,000 annually for dental care, a $350 annual allowance for eyewear, and a $1,000 yearly limit for hearing aids. Additionally, members can take advantage of a $120 monthly allowance for over-the-counter items and unlimited one-way transportation to plan-approved health locations. While many routine services are covered, certain specialized treatments like cardiac rehabilitation are excluded from the plan.
Inpatient Hospital See details
Solis Guardian Plan (HMO D-SNP) offers partially covered inpatient hospital services, providing acute and psychiatric stays with no copay and no coinsurance, though prior authorization and referrals are required. Under this benefit, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and outpatient blood services. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Solis Guardian Plan (HMO D-SNP) covers partial hospitalization services with no coinsurance and copays ranging from no copay up to $180. Prior authorization and a referral are required to access these covered services.
Ambulance and Transportation Services See details
Solis Guardian Plan (HMO D-SNP) covers air ambulance services with a 20% coinsurance and no copay, while ground ambulance services are not covered. Unlimited one-way transportation to plan-approved health locations is offered with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance for both emergency and urgently needed services. Worldwide emergency services are partially covered up to a $75,000 maximum benefit with no copay or coinsurance, but worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Solis Guardian Plan (HMO D-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. While routine chiropractic and podiatry are covered, other chiropractic services, as well as individual and group sessions for both psychiatric and mental health specialty services, are not covered.
Preventive Services See details
Solis Guardian Plan (HMO D-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and memory fitness. However, these benefits are only partially covered, as services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and therapeutic massages are not covered.
Hearing Services See details
Solis Guardian Plan (HMO D-SNP) partially covers hearing services, providing annual routine exams, fittings, and prescription hearing aids up to a $1,000 yearly limit with no copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, as other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to a $350 annual maximum for eyewear, including contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance up to an annual maximum of $4,000. While many preventive and comprehensive services are included, 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 partially covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B insulin is covered, but Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Solis Guardian Plan (HMO D-SNP) 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 Guardian Plan (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, subject to prior authorization and preferred vendor limitations. While some diabetic equipment and non-Medicare prosthetic services are covered with no copay or coinsurance, specific sub-services including diabetic supplies, therapeutic shoes or inserts, prosthetic devices, and medical supplies are not covered.
Diagnostic and Radiological Services See details
Solis Guardian Plan (HMO D-SNP) covers Diagnostic and Radiological Services with no copay and no coinsurance, but only some services are covered as diagnostic procedures, lab services, radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Home Health Services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Solis Guardian Plan (HMO D-SNP), as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded. Although the plan technically features no copay and no coinsurance for this category, no coverage is available for any of these specific rehabilitation services.
Skilled Nursing Facility (SNF) See details
Solis Guardian Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and a referral are required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond Medicare-covered days are not covered.
Other Services See details
Solis Guardian Plan (HMO D-SNP) provides coverage for select other services, including a meal benefit for chronic illnesses (referral required) and over-the-counter (OTC) items up to $120 monthly, both with no copay and no coinsurance. However, acupuncture, Naloxone, and other additional services are not covered under this plan.
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