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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 Broward. 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 deductible for prescription drugs. During the initial coverage phase, you'll pay 25% coinsurance for most drugs at standard pharmacies, and no copay for specialty tier drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium is $20.30.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers a range of benefits, including inpatient and outpatient hospital services, emergency care, and primary care, all with no copay. Preventive services, such as routine exams and screenings, are also covered with no copay. Additionally, this plan provides coverage for hearing, vision, and dental services, offering annual allowances for hearing aids, eyewear, and dental care. This plan also provides coverage for ambulance services, home health, and medical equipment with no copay. Other notable benefits include dialysis services with a 20% coinsurance, and coverage for acupuncture treatments. It also provides an allowance for over-the-counter items and meal benefits for those with chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. Prior authorization and a doctor referral are required for both acute and psychiatric care.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, excluding individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Guardian Plan (HMO D-SNP), but requires prior authorization and a doctor referral. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Solis Guardian Plan (HMO D-SNP), with all ambulance services 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, while 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 by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care services, including Chiropractic, Occupational Therapy, Physician Specialist, Podiatry, Other Health Care Professional, Psychiatric, Physical Therapy, Speech-Language Pathology, Additional Telehealth, and Opioid Treatment Program services are covered. Mental Health Specialty Services and Psychiatric Services are partially covered, with Individual and Group Sessions not covered.
Preventive Services See details
The Solis Guardian Plan (HMO D-SNP) covers various preventive services, including Medicare-covered services with no copay, annual physical exams, additional preventive services, health education, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following welcome visit, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies. However, in-home safety assessments, personal emergency response systems, 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, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams and fitting/evaluation for hearing aids, both of which are unlimited. Prescription hearing aids are covered with a maximum benefit of $1,500 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
The Solis Guardian Plan (HMO D-SNP) offers dental services, including oral exams, dental x-rays (1 every three years), other diagnostic services, cleaning, fluoride treatment, other preventive services, and orthodontic services. This plan has a $5,000 annual maximum for dental services. Restorative services, periodontics (1 every two years), prosthodontics (removable) (1 every 5 years), implant services (1 every 10 years), and prosthodontics (fixed) (1 every 5 years) are covered. 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), including Insulin and Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. There is a 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment is covered by the Solis Guardian Plan (HMO D-SNP), including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, both with no copay and no coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment is also covered, though Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Solis Guardian Plan (HMO D-SNP) offers diagnostic and radiological services, but some services are not covered. There is no copay for covered services, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Solis Guardian Plan (HMO D-SNP) covers Cardiac Rehabilitation Services, 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 per 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 provides up to $125 per month for Over-the-Counter (OTC) items, including nicotine replacement therapy. The plan also covers meal benefits for a chronic illness with a doctor referral. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, or any of the listed "Other Services" such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management (Long Term Care), among others.
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