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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 Palm Beach. 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. After the deductible, you will pay 25% coinsurance for most drugs at a standard pharmacy. The plan has no copay for specialty tier drugs at a standard pharmacy. If you qualify for the low-income subsidy, your Part D premium will be $20.30 per month.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers a range of benefits, including coverage for inpatient and outpatient services, and several primary care and preventive services, such as routine exams and vision services. The plan also provides coverage for dental services with a $5,000 annual maximum, hearing services with a $1,500 annual maximum for hearing aids, and medical equipment with no copay. Additional benefits include coverage for ambulance and transportation services, emergency services with worldwide coverage, and various other services like home health, home infusion, and dialysis services, with specific requirements like prior authorization or referrals. The plan also covers over-the-counter items up to $125 per month, and offers a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered and require prior authorization and a doctor's referral. Additional days for acute and psychiatric care, non-Medicare-covered stays, and upgrades for acute care are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse individual and group sessions are not covered.
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 benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Solis Guardian Plan (HMO D-SNP). All Ambulance Services are covered with no copay and no coinsurance, but Ground and Air Ambulance Services are not covered. Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance.
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 or coinsurance, and Worldwide Emergency Coverage is also covered. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered. Worldwide Emergency Services has a maximum plan benefit coverage amount of $75,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, and Chiropractic Services have no copay and no coinsurance. Individual and Group Sessions for Mental Health Specialty Services and Individual and Group Sessions for 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, fitness benefits, remote access technologies, kidney disease education services, and other preventive services. 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, weight management programs, alternative therapies, therapeutic massage, adult day health services, home and bathroom safety devices, counseling services, enhanced disease management, telemonitoring services, and support for caregivers are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams and fitting/evaluation for hearing aids, with no deductible, and prescription hearing aids (all types) with a maximum plan benefit of $1500 per year. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered under the Solis Guardian Plan (HMO D-SNP), including routine eye exams with no copay and eyewear with a combined maximum benefit of $300 every year. Contact lenses, eyeglass lenses and frames, and upgrades are covered, with no copay.
Dental Services See details
The Solis Guardian Plan (HMO D-SNP) covers a variety of dental services with a maximum benefit of $5,000 per year. Oral exams, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery are covered, while dental x-rays have a limit of 1 every three years, and restorative services, prosthodontics (removable and fixed), implant services, and periodontics have a limit of 1 visit every 5, 10, and 2 years, respectively. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Solis Guardian Plan (HMO D-SNP). Insulin, including Medicare Part B Insulin Drugs, is covered, while 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. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Solis Guardian Plan (HMO D-SNP), with no copay or coinsurance for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, but some sub-services are not covered. The plan does not cover Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The Solis Guardian Plan (HMO D-SNP) covers diagnostic and radiological services, though specific services such as diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered. There is no copay for 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, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor's referral and prior authorization are required.
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. This benefit requires prior authorization and a doctor referral, and covers two days per admission or per stay.
Other Services See details
The Solis Guardian Plan (HMO D-SNP) covers acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a limit of 24 treatments per year, and requires prior authorization. OTC items are covered up to $125.00 per month, and the plan also offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. The meal benefit is for a chronic illness and requires a doctor's referral. Some services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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