A non-government entity
Solis Healthy Living Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Healthy Living Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Healthy Living Plan (HMO) in 2026, please refer to our full plan details page.
Solis Healthy Living Plan (HMO) is a HMO plan offered by Athena Healthcare Holdings, LLC available for enrollment in 2025 to people living in Polk. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Solis Healthy Living Plan (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Solis Healthy Living Plan (HMO).
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 Healthy Living Plan (HMO), 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 Healthy Living Plan (HMO) features a $0 drug deductible, allowing members to access prescription benefits immediately without upfront costs. Members enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications for 1-month, 2-month, and 3-month supplies at standard pharmacies, as well as for 3-month standard mail orders. Additionally, there is no copay for a 1-month supply of Tier 6 (Supplemental Drugs) at standard pharmacies. For higher-tier medications, costs vary by drug class at standard pharmacies. Tier 3 (Preferred Brand) drugs require a copay of $15 for a 1-month supply, $30 for a 2-month supply, and $40 for a 3-month supply. Tier 4 (Non-Preferred Drug) prescriptions carry a $75 copay for a 1-month supply, while Tier 5 (Specialty Tier) medications require a 33% coinsurance for a 1-month supply.
Additional Benefits
The Solis Healthy Living Plan (HMO) features comprehensive medical coverage with no copays or coinsurance for primary care, specialist visits, telehealth, and preventive services. For hospital care, inpatient stays require a $30 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry an $85 copay with no coinsurance. Emergency services are available with a $120 copay, which is waived if admitted, and urgent care visits require no copay. This plan also provides robust supplemental benefits, including dental care up to a $3,000 annual limit and routine hearing and vision exams with no copays or coinsurance. Additionally, members receive a $135 monthly allowance for over-the-counter items and up to 24 free one-way trips per year to plan-approved locations. Eyewear is covered up to $250 annually, and hearing aids are covered up to $1,250 per year, both featuring no copays or coinsurance.
Inpatient Hospital See details
Solis Healthy Living Plan (HMO) offers partially covered inpatient hospital care with no coinsurance and a $30 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered under this plan.
Outpatient Services See details
Solis Healthy Living Plan (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require an $85 copay, observation services cost a $50 copay per stay, and outpatient substance abuse sessions have a $40 copay, all with no coinsurance.
Partial Hospitalization See details
Solis Healthy Living Plan (HMO) covers partial hospitalization services with no coinsurance and a copayment of either $55.00 or $180.00. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by the Solis Healthy Living Plan (HMO), with ground ambulance services requiring a $150 copay and air ambulance services requiring a 20% coinsurance that is waived if admitted. Transportation to plan-approved locations is covered with no copay or coinsurance for up to 24 one-way trips per year, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Solis Healthy Living Plan (HMO) with a $120 copay—waived if admitted to the hospital within 24 hours—and no coinsurance, while urgently needed services feature no copay or coinsurance. Worldwide emergency services are partially covered up to a $75,000 lifetime maximum with a $120 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Healthy Living Plan (HMO) provides primary care, specialist, telehealth, and podiatry services with no copay and no coinsurance, while chiropractic care is partially covered with no copay or coinsurance for up to 12 routine visits per year, excluding other chiropractic services. Mental health, psychiatric, and opioid treatment services require copays ranging from $20 to $40 with no coinsurance, and physical, occupational, and speech therapies have a $10 to $40 copay with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance for covered options like annual physicals and kidney disease education. However, several supplemental services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and therapeutic massage.
Hearing Services See details
Solis Healthy Living Plan (HMO) covers routine hearing exams and fitting evaluations annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,250 yearly limit, though over-the-counter, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Solis Healthy Living Plan (HMO) partially covers vision services with no copay and no coinsurance, as other eye exam services are not covered. Covered benefits include one routine eye exam annually and up to $250 per year for eyewear, including contact lenses, eyeglasses, and upgrades.
Dental Services See details
Solis Healthy Living Plan (HMO) offers partially covered dental services with no copay and no coinsurance up to an annual maximum benefit of $3,000. Specific services not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Solis Healthy Living Plan (HMO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Solis Healthy Living Plan (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Solis Healthy Living Plan (HMO) partially covers medical equipment with no copays, though prior authorization is required for all covered items. Durable medical equipment has a coinsurance of 0% to 20%, and prosthetic devices and diabetic shoes or inserts carry a 20% coinsurance, while medical supplies and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the Solis Healthy Living Plan (HMO), as lab services are not covered. Covered diagnostic procedures and tests carry no coinsurance and a copay of $0 to $50, outpatient x-rays and diagnostic radiological services have no copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Solis Healthy Living Plan (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Solis Healthy Living Plan (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by the Solis Healthy Living Plan (HMO) with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and a $150 daily copay for days 21 through 100 per stay, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Solis Healthy Living Plan (HMO) partially covers Other Services, offering over-the-counter (OTC) items up to $135 per month and chronic illness meal benefits with a referral, both with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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