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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 Hillsborough, Pasco, Pinellas. 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. Additionally, this plan comes with a Part B Premium reduction of $6.50. You must continue to pay paying your reduced 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) features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs at standard pharmacies for one-month, two-month, or three-month supplies, as well as 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 brand-name and specialty medications, standard pharmacy copays and coinsurance will apply. Tier 3 (Preferred Brand) drugs require a copay of $25 for a one-month supply, $50 for a two-month supply, and $70 for a three-month supply, while Tier 4 (Non-Preferred Drugs) carry a $75 copay for a one-month supply. Tier 5 (Specialty Tier) drugs are subject to a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers affordable healthcare coverage with no copay or coinsurance for primary care, specialist visits, home health services, and urgent care. Inpatient hospital stays require a low daily copay of $30 for the first five days and no copay thereafter, while outpatient services range from no copay up to an $85 copay. Emergency room visits feature a $100 copay that is waived upon admission, and ground ambulance rides have a $200 copay. Members enjoy robust supplemental benefits with no copay or coinsurance, including routine dental care up to $3,500 annually, hearing exams with a $1,000 hearing aid limit, and eye exams with a $250 eyewear allowance. The plan also includes up to 48 free one-way transportation trips to approved locations per year and a monthly $125 allowance for over-the-counter items. While many diagnostic and diabetic services have no copay, some specialized treatments like dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Solis Wellness Plan (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $30 daily copay for days 1 through 5 and no copay for days 6 through 90. This partially covered benefit requires prior authorization and referrals, and it does not cover upgrades or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services covered by the Solis Wellness Plan (HMO C-SNP) feature no coinsurance, with no copay required for ambulatory surgical center and blood services. Copays of $40 apply to outpatient substance abuse sessions, $50 per stay for observation services, and $85 for outpatient hospital services, with referrals or prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the Solis Wellness Plan (HMO C-SNP) with no coinsurance, but requires a copay of either $55.00 or $180.00 depending on the service. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Solis Wellness Plan (HMO C-SNP) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 48 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Solis Wellness Plan (HMO C-SNP) covers emergency services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services are covered with no copay or coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum benefit with a $100 copay and no coinsurance for emergency care, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Wellness Plan (HMO C-SNP) provides primary care, specialist, telehealth, and routine podiatry services with no copay and no coinsurance. Physical, occupational, and speech therapies require a $10 to $40 copay, mental health visits have a $20 copay, and routine chiropractic care is partially covered with no copay for up to 12 visits per year.
Preventive Services See details
Preventive services are partially covered by the Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physical exams and kidney disease education. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Solis Wellness Plan (HMO C-SNP) covers routine hearing exams and fitting evaluations once per year with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual limit, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Solis Wellness Plan (HMO C-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam per year and a $250 annual allowance for eyewear, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by the Solis Wellness Plan (HMO C-SNP), offering no copay and no coinsurance for covered treatments up to a maximum annual benefit of $3,500. While many preventive and comprehensive services are covered, other diagnostic dental services, other preventive dental services, 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 are required. Under this benefit, Medicare Part B insulin features no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Solis Wellness Plan (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is partially covered by the Solis Wellness Plan (HMO C-SNP), as medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered. Covered durable medical equipment (DME) features no copay and 0% to 20% coinsurance, prosthetic devices require no copay and 20% coinsurance, and diabetic equipment is offered with no copay and no coinsurance, with prior authorization required for all covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the Solis Wellness Plan (HMO C-SNP), as lab services are not covered. Diagnostic procedures and tests require no coinsurance and a $0 to $90 copay, outpatient X-rays and diagnostic radiological services feature no copay, and therapeutic services require a 20% coinsurance.
Home Health Services See details
Solis Wellness Plan (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Solis Wellness Plan (HMO C-SNP), as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Solis Wellness Plan (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $150 copay for days 21 through 100 per stay. Prior authorization and referrals are required for this benefit, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Solis Wellness Plan (HMO C-SNP) partially covers other services, offering over-the-counter (OTC) items up to $125 monthly and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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