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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 Palm Beach. 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 Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for one-month, two-month, or three-month supplies filled at a standard pharmacy, as well as no copay 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, members are responsible for a 25% coinsurance at standard pharmacies. Specifically, Tier 3 preferred brand drugs require a 25% coinsurance for one-month, two-month, and three-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty tier drugs also carry a 25% coinsurance for a one-month supply.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive healthcare coverage featuring no copays and no coinsurance for the vast majority of its primary medical services. Members enjoy cost-free access to inpatient and outpatient hospital stays, emergency services, primary and specialist care, and preventive screenings. This plan also includes robust supplemental benefits with no copays, such as dental care up to a $5,000 annual limit, vision care with a $300 eyewear allowance, and hearing services with a $1,500 hearing aid allowance. Additionally, the plan features unlimited one-way transportation to plan-approved locations and a $118 monthly over-the-counter allowance at no cost. While most benefits are fully covered, members should expect a 20% coinsurance for dialysis services and air ambulance transport, as well as copays ranging up to $180 for partial hospitalization. Please note that many of these medical and supplemental services require prior authorization or referrals to be covered.
Inpatient Hospital See details
Solis Guardian Plan (HMO D-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance, though referrals and prior authorization 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 outpatient blood services with no copay and no coinsurance. Outpatient substance abuse services are not covered under this plan because both individual and group sessions are excluded.
Partial Hospitalization See details
Partial hospitalization is covered under the Solis Guardian Plan (HMO D-SNP) with copays ranging from no copay to $180 and no coinsurance. Both prior authorization and referrals are required for these services.
Ambulance and Transportation Services See details
Solis Guardian Plan (HMO D-SNP) partially covers ambulance and transportation services, featuring unlimited one-way trips to plan-approved locations with no copay and no coinsurance. Air ambulance services are covered with a 20% coinsurance and no copay (prior authorization required), but ground ambulance services and transportation to any health-related location are not covered.
Emergency Services See details
Emergency services and urgently needed services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum limit with no copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary care, specialist, therapy, and telehealth services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, though referrals or prior authorizations are required. Chiropractic services are partially covered, offering 12 routine visits per year while excluding other chiropractic services, whereas mental health and psychiatric specialty sessions are not covered.
Preventive Services See details
Solis Guardian Plan (HMO D-SNP) covers preventive services, annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, excluding sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and home safety modifications.
Hearing Services See details
Solis Guardian Plan (HMO D-SNP) offers hearing services with no copay and no coinsurance, which includes one routine hearing exam and one fitting evaluation per year, alongside a $1,500 annual maximum coverage for prescription hearing aids. This benefit is partially covered, as OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Solis Guardian Plan (HMO D-SNP) covers vision services with no copay and no coinsurance, including one routine eye exam per year and a $300 annual allowance for eyewear. Other eye exam services are not covered, and referrals or prior authorizations are required for coverage.
Dental Services See details
Dental services are partially covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance for covered services up to a $5,000 annual maximum. While many preventive and comprehensive benefits like cleanings, exams, and implants are covered, other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Solis Guardian Plan (HMO D-SNP) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with no copay or coinsurance, 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 rules. While diabetic equipment and non-Medicare prosthetics are technically covered with no copay and no coinsurance, specific items such as diabetic supplies, therapeutic shoes, prosthetic devices, and medical supplies are not covered in practice.
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, meaning some services are covered, but diagnostic procedures and 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 and no coinsurance. Both a referral and prior authorization 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, though prior authorization and referrals are required. 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. While the plan allows for SNF admission without a prior three-day inpatient hospital stay, additional days beyond standard Medicare-covered days are not covered.
Other Services See details
Solis Guardian Plan (HMO D-SNP) partially covers other services, which include a $118 monthly over-the-counter (OTC) item allowance and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture, naloxone OTC coverage, and other additional services are not covered under this benefit.
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