A non-government entity
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 Palm Beach. 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 $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:
Sign up for Solis Wellness Plan (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Solis Wellness Plan (HMO C-SNP) has an enhanced alternative drug benefit. This plan has no deductible. In the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy. For example, you'll pay a $0 copay for preferred generic drugs, $15 for standard generic drugs, and $75 for preferred brand drugs. Once your total drug costs reach $2000, you will enter the next coverage phase. In the catastrophic coverage phase, you pay nothing for Part D covered drugs.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers a range of benefits with varying costs. Many services, like routine eye exams, hearing exams, and some preventive services, come with no copay. Other services, such as outpatient services and emergency services, have copays ranging from $25 to $120, and some services like ambulance and dialysis services have coinsurance. The plan also includes coverage for dental, vision, and hearing services. Dental services have a $3,500 annual maximum, while vision includes eyewear benefits up to $250 per year. Hearing aids are covered up to $1,500 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered for 1 day per benefit period, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $25 copay; individual and group sessions for outpatient substance abuse have a $40 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Solis Wellness Plan (HMO C-SNP) with a $55 copay, and prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $100 copay, while Air Ambulance Services have a 20% coinsurance; Transportation Services to a plan-approved health-related location are also covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Solis Wellness Plan (HMO C-SNP), with a $25 copay for Emergency Services and no copay for Urgently Needed Services. Worldwide Emergency Coverage has a $120 copay, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Wellness Plan (HMO C-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy services have a copay between $10 and $40, and individual and group sessions for mental health and psychiatric services have a $20 copay; physical therapy and speech-language pathology services have a copay between $10 and $40, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services, 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. This plan does not cover 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, or counseling services.
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 $1,500 per year, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Solis Wellness Plan (HMO C-SNP) covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum benefit of $250 per 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 $3,500 annual maximum. 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 are limited to one every three years, and restorative services, periodontics, prosthodontics (removable), implant services, and prosthodontics (fixed) are limited to one visit every 5 or 10 years. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is a coinsurance for these services, ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Wellness Plan (HMO C-SNP), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and no copay. Prosthetic Devices have a 20% coinsurance, and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Solis Wellness Plan (HMO C-SNP). Diagnostic Procedures/Tests have a maximum copay of $50, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $75, Therapeutic Radiological Services have a maximum copay of $60, 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. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but this 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Solis Wellness Plan (HMO C-SNP), with a doctor referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, there is a $50 copay.
Other Services See details
The Solis Wellness Plan (HMO C-SNP) covers acupuncture with prior authorization, up to 24 treatments per year. Over-the-counter (OTC) items are covered up to $114 per month, and the plan offers a meal benefit, but other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved