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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 2025, 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 4 out of 5 stars in 2025.
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 $20.30. 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 $590.00 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) has a $590.00 deductible for prescription drugs. After the deductible, you will pay 25% coinsurance for most drugs, depending on the pharmacy and drug tier. For those who qualify for the low-income subsidy (LIS), the plan premium is $20.30. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive coverage, including inpatient and outpatient services, with no copay for emergency, ambulance, and home health services. This plan also covers a range of services such as primary care, preventive services, hearing, vision, dental, and home infusion, with varying cost-sharing structures like coinsurance for dialysis and a yearly maximum for dental. Additional benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities, as well as acupuncture with a limit of 24 treatments per year. The plan also provides an over-the-counter (OTC) benefit with a monthly maximum and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. Prior authorization and a doctor referral are required.
Outpatient Services See details
Outpatient Services are covered by the Solis Guardian Plan (HMO D-SNP), including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, but individual and group sessions for outpatient substance abuse are not covered. Prior authorization and a doctor referral are required for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, and a doctor referral is required for outpatient substance abuse services. The plan waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Guardian Plan (HMO D-SNP) with prior authorization and a doctor referral required. There is no information about cost provided in this snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under the Solis Guardian Plan (HMO D-SNP); all ambulance services are covered with no copay or coinsurance, but ground and air ambulance services are not covered. Transportation Services to a plan-approved health-related location are covered with no copay or coinsurance, and are unlimited, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, but Worldwide Emergency Services has a maximum plan benefit coverage amount of $75,000. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Guardian Plan (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
The Solis Guardian Plan (HMO D-SNP) covers preventive services, including annual physical exams, health education, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling, a fitness benefit, remote access technologies, kidney disease education services, and other preventive services. Some services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1000 every year, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams, with one exam covered every year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. A combined maximum of $350.00 is covered every year for eyewear.
Dental Services See details
The Solis Guardian Plan (HMO D-SNP) covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and implant services, with a maximum benefit of $4,000 per year. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Solis Guardian Plan (HMO D-SNP), with prior authorization required. Insulin benefits are covered under Medicare Part B, and there is no copay or coinsurance. However, Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Solis Guardian Plan (HMO D-SNP) and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, are covered with no copay and no coinsurance, but some services are not covered, including Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. DME and Prosthetics/Medical Supplies require authorization.
Diagnostic and Radiological Services See details
The Solis Guardian Plan (HMO D-SNP) covers diagnostic and radiological services, but diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required, and the plan covers two days per admission or stay.
Other Services See details
The Solis Guardian Plan (HMO D-SNP) covers acupuncture, with a limit of 24 treatments per year, and requires prior authorization. This plan also covers over-the-counter (OTC) items, offering a maximum benefit of $125.00 every month, and provides a meal benefit for chronic illnesses with a doctor's referral. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services and many other services are not covered.
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