A non-government entity
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 Polk. 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:
Sign up for Solis Wellness Plan (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Solis Wellness Plan (HMO C-SNP) has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy used. For example, for preferred generic drugs, you will have no copay at a standard pharmacy. For standard generic drugs, you will pay a $15 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the next phase. In the catastrophic coverage phase, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers a range of benefits, including inpatient and outpatient hospital services with copays, as well as ambulance and emergency services. The plan also covers primary care, preventive services, hearing, vision, and dental services, with varying copays and maximum benefit amounts. Additional benefits include home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance. The plan also covers home health services with no copay, and skilled nursing facility stays with a copay after 20 days. Other services such as acupuncture, over-the-counter items, and meal benefits are covered, with limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization and a doctor's referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $30 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, 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 and observation services, are covered by the Solis Wellness Plan (HMO C-SNP) with copays of $85 and $50, respectively. Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services (with a $40 copay for both individual and group sessions), and Outpatient Blood Services are also covered, with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Wellness Plan (HMO C-SNP) with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Solis Wellness Plan (HMO C-SNP). 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 also covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, are covered under the Solis Wellness Plan (HMO C-SNP) with a $75 copay, and no coinsurance; Urgently Needed Services are covered with no copay or coinsurance. 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, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $40, while Individual and Group Sessions for Mental Health and Psychiatric Services have a $20 copay, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services, including annual physical exams and additional preventive services, are covered by the Solis Wellness Plan (HMO C-SNP). The plan also covers health education, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, and other preventive services like glaucoma screening, with a referral required for some services.
Hearing Services See details
Hearing Services are covered by the Solis Wellness Plan (HMO C-SNP), including routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a maximum plan benefit of $1,000 per year for prescription hearing aids. Prescription hearing aids - inner ear, outer ear, and over the ear, 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 deductible, and eyewear with a $250 combined maximum plan benefit per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered. A doctor referral is required for eye exams and eyewear.
Dental Services See details
The Solis Wellness Plan (HMO C-SNP) offers dental services with a $4,000 maximum benefit per year. Oral exams, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery are covered. Dental X-rays are limited to one every three years, and restorative services, periodontics, prosthodontics (removable and fixed), and implant services are limited to one visit within a specific timeframe. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Wellness Plan (HMO C-SNP), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Solis Wellness Plan (HMO C-SNP), with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices are covered with a 20% coinsurance, but Medical Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Solis Wellness Plan (HMO C-SNP). Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $50, and Therapeutic Radiological Services have a coinsurance of 20%. 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 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 Wellness Plan (HMO C-SNP). This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Solis Wellness Plan (HMO C-SNP), 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. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF 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. Over-the-counter (OTC) items are covered with a maximum benefit coverage amount of $135.00 per month, and the plan offers nicotine replacement therapy. Meal benefits are also covered with prior authorization and a doctor referral. However, several other services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many more.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved