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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 Polk. 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.
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) features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies for one-, two-, or three-month supplies, as well as three-month supplies filled via standard mail order. Additionally, Tier 6 supplemental drugs carry no copay for a one-month supply at standard pharmacies. For brand-name and specialty medications, costs vary depending on the drug tier and supply. Tier 3 (Preferred Brand) drugs at standard pharmacies require a copay of $15 for a one-month supply, $30 for a two-month supply, or $40 for a three-month supply. Tier 4 (Non-Preferred) drugs carry a $75 copay for a one-month supply, while Tier 5 (Specialty Tier) drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers robust coverage for core medical services with many essential benefits requiring no copay or coinsurance, including primary care, specialist visits, and preventive care. For hospital stays, members pay a low daily copay of $30 for the first five days of inpatient care and no copay for subsequent days, while emergency room visits carry a $100 copay that is waived if admitted. Outpatient hospital services and diagnostic tests are also highly affordable, featuring low copays and no coinsurance for most procedures. This plan also provides excellent supplemental benefits, including no copays or coinsurance for routine dental care up to a $4,000 annual limit, routine vision care with a $250 eyewear allowance, and hearing services up to a $1,000 limit. Additionally, members receive up to 48 free one-way transportation trips per year to approved health locations and a monthly over-the-counter allowance of $135 with no copay. While specialized services like dialysis and certain Part B drugs require a 20% coinsurance, the plan minimizes out-of-pocket expenses for everyday healthcare needs.
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 benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Solis Wellness Plan (HMO C-SNP) covers outpatient hospital services with an $85 copay and observation services with a $50 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Solis Wellness Plan (HMO C-SNP) covers partial hospitalization services with no coinsurance and a copay 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
Solis Wellness Plan (HMO C-SNP) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation benefits are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are 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 with no copay or coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Wellness Plan (HMO C-SNP) covers primary care, specialist, telehealth, and podiatry services with no copay and no coinsurance, while chiropractic care is partially covered with no copay or coinsurance as other chiropractic services are not covered. Physical, occupational, and speech therapy services require a $10 to $40 copay, mental health and psychiatric services carry a $20 copay, and opioid treatment has a $40 copay, all with no coinsurance.
Preventive Services See details
Preventive services are covered by Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance, although referrals are required for select services. Additional preventive benefits are partially covered, excluding services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Solis Wellness Plan (HMO C-SNP) offers partially covered hearing services with no copay and no coinsurance for routine hearing exams, fitting evaluations, and prescription hearing aids up to a $1,000 annual limit. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by Solis Wellness Plan (HMO C-SNP) with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. This coverage includes one routine eye exam per year and up to $250 annually for eyewear, including contact lenses, eyeglasses, and upgrades.
Dental Services See details
Solis Wellness Plan (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance for covered treatments, up to a maximum annual benefit of $4,000. Covered services include exams, cleanings, and restorative care, while other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Solis Wellness Plan (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs feature no copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs may require step therapy and carry a coinsurance ranging from 0% to 20%.
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 covered services.
Medical Equipment See details
Solis Wellness Plan (HMO C-SNP) partially covers medical equipment, offering durable medical equipment with no copay and 0% to 20% coinsurance, prosthetic devices with no copay and 20% coinsurance, and diabetic equipment with no copay and no coinsurance. Medical supplies, diabetic supplies, and diabetic therapeutic shoes and inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Solis Wellness Plan (HMO C-SNP), with the exception of lab services which are not covered. Diagnostic procedures and tests carry no coinsurance and a copay of up to $50, outpatient X-rays and diagnostic radiology have no copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Solis Wellness Plan (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Solis Wellness Plan (HMO C-SNP).
Skilled Nursing Facility (SNF) See details
Solis Wellness Plan (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $150 copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Solis Wellness Plan (HMO C-SNP), featuring over-the-counter (OTC) items up to $135 monthly and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan.
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