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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 2026, 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 Palm Beach. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $2900.00 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) features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-, two-, or three-month supplies at standard pharmacies, 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 Tier 3 preferred brand drugs, standard pharmacy copays are $15 for a one-month supply, $30 for a two-month supply, and $40 for a three-month supply. Tier 4 non-preferred drugs carry a $75 copay for a one-month supply at standard pharmacies. If you require Tier 5 specialty drugs, there is a 33% coinsurance for a one-month supply.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers comprehensive healthcare coverage with no copay or coinsurance for inpatient hospital stays, primary care visits, specialist consultations, and home health services. Outpatient services are highly affordable, featuring no copay for ambulatory surgical center visits and low copays for diagnostic tests and outpatient hospital care. Additionally, emergency care is available with a $75 copay, which is waived if you are admitted, while urgently needed services require no copay. Members also benefit from robust supplemental coverage, including no copay for routine dental, vision, and hearing exams, alongside allowances of up to $3,500 for dental treatments and $1,500 for hearing aids. The plan further supports daily health needs by providing up to 48 free one-way transportation trips per year and a $125 monthly allowance for over-the-counter items with no copay. Durable medical equipment and dialysis services are covered with coinsurance rates ranging from 0% to 20% and no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by the Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance for both acute and psychiatric stays, though prior authorization and referrals are required. While acute care includes up to three additional days, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Solis Wellness Plan (HMO C-SNP) covers outpatient hospital and observation services with a $50 copay and no coinsurance, and outpatient substance abuse sessions with a $40 copay and no coinsurance. Ambulatory surgical center and outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Solis Wellness Plan (HMO C-SNP) covers partial hospitalization services with no coinsurance and a copayment of either $55.00 or $180.00. Both prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Solis Wellness Plan (HMO C-SNP) covers ambulance services and partially covers transportation services, as transportation to any health-related location is not covered. Ground ambulance services require a $150 copay and no coinsurance, air ambulance services carry a 20% coinsurance and no copay (waived if admitted), and plan-approved transportation offers up to 48 one-way trips per year with no copay and no coinsurance.
Emergency Services See details
Solis Wellness Plan (HMO C-SNP) covers emergency services with a $75 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a maximum of $75,000 with a $75 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Wellness Plan (HMO C-SNP) provides primary care, specialist, podiatry, and telehealth services with no copay and no coinsurance. Therapy services require a $0 to $20 copay, mental health sessions have a $20 copay, and opioid treatment has a $40 copay, all with no coinsurance. Routine chiropractic care is covered for up to 12 visits per year with no copay or coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Solis Wellness Plan (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance, though referrals are required for certain services. Covered benefits include annual physicals, nutritional training, and fitness benefits, while excluded services include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, caregiver support, additional smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by the Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance for one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,500 annual limit, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Solis Wellness Plan (HMO C-SNP) with no copay, no coinsurance, and no deductibles for routine eye exams and eyewear. Routine eye exams are limited to one per year, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, is available with no copay or coinsurance up to a $250 annual maximum, though referrals and prior authorizations are required.
Dental Services See details
Solis Wellness Plan (HMO C-SNP) dental services are partially covered with no copay and no coinsurance up to a maximum annual benefit of $3,500. Covered treatments include cleanings, exams, and restorative services, but other diagnostic dental, other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Solis Wellness Plan (HMO C-SNP) with no copay, though prior authorization and step therapy may apply. Under this benefit, Medicare Part B insulin drugs feature no copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Solis Wellness Plan (HMO C-SNP) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these services.
Medical Equipment See details
Solis Wellness Plan (HMO C-SNP) partially covers medical equipment with no copay, requiring 0% to 20% coinsurance for durable medical equipment (DME) and 20% coinsurance for prosthetic devices. Diabetic equipment is covered with no copay and no coinsurance, but medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Solis Wellness Plan (HMO C-SNP) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Diagnostic procedures and tests require a copay of $0 to $50, while outpatient X-rays, therapeutic radiology, and diagnostic radiological services have no copay.
Home Health Services See details
Home Health Services are covered by the Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Solis Wellness Plan (HMO C-SNP) offers Cardiac Rehabilitation Services where some services are covered with no copay and no coinsurance, though prior authorization and a referral are required. However, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Solis Wellness Plan (HMO C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $50 copay for days 21 through 100 per stay. Prior authorization and referrals are required, but a prior three-day inpatient hospital stay is not.
Other Services See details
Solis Wellness Plan (HMO C-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meals with no copay and no coinsurance, while acupuncture and naloxone are not covered. The plan features a $125 monthly OTC allowance and referral-based meals, ensuring key health needs are met at no cost to the member.
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