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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 2025, 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 4 out of 5 stars in 2025.
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) has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays depending on the drug tier. For example, you'll pay a $0 copay for preferred generic drugs at a standard pharmacy, and $15 for standard generic drugs. For preferred brand drugs, the copay is $75. For non-preferred drugs, you'll pay 33% coinsurance. The plan also has a specialty tier with a $0 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays varying by service, and emergency services with a $100 copay. Primary care, preventive, hearing, vision, and dental services are also covered, with specific copays, coinsurance, and annual maximums for certain services. The plan also covers home infusion, dialysis, medical equipment, and skilled nursing facility stays. Additional benefits include ambulance and transportation services, diagnostic and radiological services, and home health services. The plan also offers coverage for acupuncture, over-the-counter items, and meal benefits. However, the plan does not cover cardiac rehabilitation services, and some services are not covered, such as certain types of hearing aids, and additional hours of care.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $30 copay for days 1-5, and no copay for days 6-90; additional days and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $30 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with an $85 copay, observation services with a $50 copay, ambulatory surgical center services, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services. Prior authorization and a doctor referral may be required.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Healthy Living Plan (HMO), with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Solis Healthy Living Plan (HMO). 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 covered. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Solis Healthy Living Plan (HMO). Emergency Services and Worldwide Emergency Coverage have a $100 copay, with no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Healthy Living Plan (HMO) covers primary care services, including 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, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy and physical therapy services have a copay between $10 and $40, while individual and group sessions for mental health and psychiatric services have a $20 copay. Opioid treatment program services have a $40 copay.
Preventive Services See details
The Solis Healthy Living Plan (HMO) covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services that may not be covered by other Medicare plans. 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. Other covered services include health education, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services are covered, including routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Solis Healthy Living Plan (HMO) covers vision services, including routine eye exams once per year, 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 Healthy Living Plan (HMO) covers a yearly maximum of $3,000 for dental services, including oral exams, dental x-rays (1 every 3 years), other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services (1 every 5 years), adjunctive general services, endodontics, periodontics (1 every 2 years), prosthodontics, removable (1 every 5 years), implant services (1 every 10 years), prosthodontics, fixed (1 every 5 years), and oral and maxillofacial surgery; however, maxillofacial prosthetics and orthodontics are not covered. Prior authorization and a doctor referral are required for some services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Healthy Living Plan (HMO) and require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Solis Healthy Living Plan (HMO), with Durable Medical Equipment (DME) covered with 0-20% coinsurance and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts covered with 20% coinsurance. Durable Medical Equipment for use outside the home, Medical Supplies, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $50, and diagnostic radiological services with a copay of up to $50. Therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have no copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Solis Healthy Living Plan (HMO) with no copay or coinsurance, but authorization and a referral are required. 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 Healthy Living Plan (HMO). Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Solis Healthy Living Plan (HMO), requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
The Solis Healthy Living Plan (HMO) covers acupuncture with a limit of 24 treatments per year, and requires prior authorization. Over-the-counter (OTC) items are covered up to $135.00 per month, including nicotine replacement therapy, and meal benefits are covered with a doctor's referral. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and the following services are not covered: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), 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.
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