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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 Broward. 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) features an annual prescription drug deductible of $615. For lower-tier medications, this plan offers excellent savings with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or through a standard three-month mail-order service. Additionally, there is no copay for a one-month supply of Tier 6 (Supplemental Drugs) at standard pharmacies. For higher-tier medications, beneficiaries will pay a 25% coinsurance for Tier 3 (Preferred Brand) drugs at standard pharmacies for one-, two-, or three-month supplies. Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications also require a 25% coinsurance for a one-month supply at standard pharmacies. This straightforward cost-sharing structure helps you easily budget your healthcare expenses under this plan.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive healthcare coverage with no copays, no deductibles, and no coinsurance for the vast majority of its core services. This includes inpatient and outpatient hospital stays, primary and specialist care, preventive services, emergency care, and home health services. However, some specialized treatments do carry cost-sharing, such as a twenty percent coinsurance for dialysis and air ambulance services, and copays up to one hundred eighty dollars for partial hospitalization. In addition to standard medical care, this plan provides robust supplemental benefits featuring no copays or coinsurance, including a five thousand dollar annual dental limit and a fifteen hundred dollar annual hearing aid allowance. Members also benefit from a three hundred dollar annual eyewear allowance, unlimited transportation to approved medical locations, and a one hundred twenty dollar monthly allowance for over-the-counter items. While many of these services require prior authorization or referrals, they deliver significant cost savings on everyday health needs.
Inpatient Hospital See details
Solis Guardian Plan (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Solis Guardian Plan (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance, although referrals and prior authorizations are required for most services. For outpatient substance abuse services, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Solis Guardian Plan (HMO D-SNP) covers partial hospitalization services with copays ranging from no copay to $180 and no coinsurance. Both prior authorization and referrals are required for these covered services.
Ambulance and Transportation Services See details
Solis Guardian Plan (HMO D-SNP) offers partially covered ambulance services, featuring air ambulance coverage with a 20% coinsurance and no copay, while ground ambulance services are not covered. Unlimited transportation to plan-approved health-related locations is covered with no copay and no coinsurance, but transportation to any other health-related location is not covered.
Emergency Services See details
Solis Guardian Plan (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered with no copay and no coinsurance up to a $75,000 maximum benefit, though worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Solis Guardian Plan (HMO D-SNP) offers primary care benefits with no copay and no coinsurance for covered services, including PCP visits, specialist care, therapy, and routine podiatry. Chiropractic care is partially covered, with other chiropractic services not covered, while mental health and psychiatric benefits have some services covered, although individual and group sessions are not covered.
Preventive Services See details
Preventive services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, although referrals are required for certain screenings and exams. Additional preventive benefits are partially covered, excluding services such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and weight management programs.
Hearing Services See details
Solis Guardian Plan (HMO D-SNP) covers hearing services with no copay and no coinsurance, which includes one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered up to a $1,500 annual limit with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription devices are not covered.
Vision Services See details
Solis Guardian Plan (HMO D-SNP) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam per year and a $300 annual allowance for eyewear and upgrades. This benefit is partially covered, as other eye exam services are not covered by the plan.
Dental Services See details
Solis Guardian Plan (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $5,000. While many preventive and comprehensive services are covered, orthodontics, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services 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, though prior authorization and step therapy are required. While Medicare Part B insulin drugs are covered with no copay and no coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required for these 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 rules. While some diabetic equipment and prosthetic services are covered with no copay or coinsurance, specific sub-services such as diabetic supplies, diabetic therapeutic shoes or inserts, prosthetic devices, and medical supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, though referrals and prior authorizations are required. While some services are covered, diagnostic procedures and tests, lab services, diagnostic and therapeutic radiological services, and outpatient X-ray services 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. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Solis Guardian Plan (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, requiring prior authorization and a referral. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
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. The plan allows admission without a prior three-day inpatient hospital stay and charges no cost-sharing on the day of discharge, but does not cover additional SNF days beyond what Medicare covers.
Other Services See details
Other services under the Solis Guardian Plan (HMO D-SNP) are partially covered, offering over-the-counter (OTC) items up to $120 per month and chronic illness meal benefits with a referral, both featuring no copay and no coinsurance. Acupuncture and Naloxone are not covered under these benefits, and unused OTC balances do not roll over to the next month.
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