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Solis Wellness Plan (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Wellness Plan (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Wellness Plan (HMO C-SNP) in 2025, please refer to our full plan details page.
Solis Wellness Plan (HMO C-SNP) is a HMO C-SNP plan offered by Athena Healthcare Holdings, LLC available for enrollment in 2025 to people living in Miami-Dade. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Solis Wellness Plan (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Solis Wellness Plan (HMO C-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 Wellness Plan (HMO C-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 Wellness Plan (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2500.00 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 Wellness Plan (HMO C-SNP) has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a $0 copay for preferred and standard generic drugs, and specialty tier drugs. For preferred brand drugs, you will pay a $10 copay. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you will enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers a range of benefits, including coverage for inpatient and outpatient hospital services, emergency care, and primary care services. The plan also provides coverage for hearing, vision, and dental services, with specific limits and copays for each. Additional benefits include coverage for ambulance services, home health, and skilled nursing facilities, along with services like acupuncture and over-the-counter items. Many services require prior authorization and referrals, and cost-sharing varies depending on the service, with some services having no copay.
Inpatient Hospital See details
The Solis Wellness Plan (HMO C-SNP) covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization and a doctor referral required. Additional Days for Inpatient Hospital-Acute are covered for 3 days per benefit period, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric 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 hospital and observation services each have a $25 copay, while outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Wellness Plan (HMO C-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 include coverage for air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations. Ground ambulance services and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Solis Wellness Plan (HMO C-SNP). Emergency Services have a $25 copay and no coinsurance, while Worldwide Emergency Coverage has a $50 copay and no coinsurance.
Primary Care See details
The Solis Wellness Plan (HMO C-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits and opioid treatment program services. Mental health specialty services for individual and group sessions are not covered.
Preventive Services See details
Preventive Services are covered by the Solis Wellness Plan (HMO C-SNP), 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, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit. 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 of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered by the Solis Wellness Plan (HMO C-SNP), including routine hearing exams, and fitting/evaluation for hearing aids, with no copay or coinsurance. Prescription hearing aids are covered up to a maximum of $2,000 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Solis Wellness Plan (HMO C-SNP) covers vision services, including routine eye exams with 1 visit per year, and eyewear with a combined maximum benefit of $350 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Solis Wellness Plan (HMO C-SNP) covers dental services with a maximum plan benefit of $3,500 per year. This plan covers oral exams, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery with no copay. Dental X-rays are covered once every three years, and restorative services, periodontics, prosthodontics (removable), implant services, and prosthodontics (fixed) are covered once every 5 years. Maxillofacial Prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Solis Wellness Plan (HMO C-SNP). Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Wellness Plan (HMO C-SNP). This benefit requires prior authorization and a doctor's referral, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Solis Wellness Plan (HMO C-SNP). Diagnostic Procedures/Tests have a copay between $0 and $20, while Diagnostic Radiological Services have a copay of at most $35, Therapeutic Radiological Services have a copay of at most $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice as the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and 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 by the Solis Wellness Plan (HMO C-SNP), requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $50 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Solis Wellness Plan (HMO C-SNP) covers acupuncture with a limit of 24 treatments per year, and over-the-counter (OTC) items, including nicotine replacement therapy, up to $111.00 per month. The plan also covers a meal benefit for chronic illness or medical conditions requiring the enrollee to stay home, but does not cover Dual Eligible SNPs with Highly Integrated Services, or other services including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others.
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