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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 Hillsborough, Pasco, Pinellas. 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. This plan has no deductible. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, $15 for standard generic drugs, and $75 for preferred brand drugs. You will pay 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers a wide array of benefits, including coverage for inpatient and outpatient services, with varying copays for different services. Emergency services, primary care, and preventive services, such as annual physical exams, are covered, often with no copay. The plan also includes coverage for hearing, vision, and dental services, with specific annual maximums for hearing aids and eyewear, and a $3,500 maximum for dental services. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for medical equipment. The plan also offers acupuncture, an over-the-counter (OTC) item benefit, and a meal benefit. However, certain services like Cardiac Rehabilitation, and certain diagnostic and therapeutic services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $30 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $30 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Solis Wellness Plan (HMO C-SNP). Outpatient hospital services have a $85 copay, while observation services have a $50 copay. Individual and group sessions for outpatient substance abuse have a minimum and maximum copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Wellness Plan (HMO C-SNP) with prior authorization and a doctor referral. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services. Ground ambulance services have a $200 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, while services to any other 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 and Worldwide Emergency Coverage have a $75 copay, and Urgently Needed Services has no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services (with a doctor referral), Occupational Therapy Services (with a $10-$40 copay), Physician Specialist Services (with a doctor referral), Mental Health Specialty Services (with a $20 copay for individual and group sessions), Podiatry Services (with a doctor referral), Other Health Care Professional (with a doctor referral), Psychiatric Services (with a $20 copay for individual and group sessions), Physical Therapy and Speech-Language Pathology Services (with a $10-$40 copay and prior authorization), Additional Telehealth Benefits (with a doctor referral), and Opioid Treatment Program Services (with a $40 copay and prior authorization).
Preventive Services See details
Preventive Services, including annual physical exams, are covered by the Solis Wellness Plan (HMO C-SNP) with no copay. Additional services include Health Education, Nutritional/Dietary Benefit, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling (12 visits), Fitness Benefit (Memory Fitness), Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, and prescription hearing aids (all types) with a maximum plan benefit of $1,000 per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - 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 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 maximum plan benefit of $3,500 per year. Oral exams, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery are covered with no copay or coinsurance. Dental X-rays are covered once every three years. Restorative services, implant services, prosthodontics (removable and fixed), and periodontics are covered and require a doctor referral. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Solis Wellness Plan (HMO C-SNP), with prior authorization required. The plan covers Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Solis Wellness Plan (HMO C-SNP) and require prior authorization and a doctor's referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical equipment is covered under the Solis Wellness Plan (HMO C-SNP), including durable medical equipment (DME) with 0% to 20% coinsurance, and prosthetic devices with 20% coinsurance. Durable medical equipment for use outside the home, diabetic supplies, and diabetic therapeutic shoes/inserts are not covered, and medical supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $90, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $90, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray 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, but require prior authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Solis Wellness Plan (HMO C-SNP). Specifically, 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) benefits are covered by the Solis Wellness Plan (HMO C-SNP), with a doctor's referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, there is a $150 copay. 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 prior authorization, up to 24 treatments per year. It also covers Over-the-Counter (OTC) items, including nicotine replacement therapy, with a maximum benefit of $110.00 per month. The plan also covers a meal benefit with a doctor referral and prior authorization. However, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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