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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 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 Miami-Dade. 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. Additionally, this plan comes with a Part B Premium reduction of $3.10. You must continue to pay paying your reduced 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, meaning your prescription drug coverage begins immediately without any upfront out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 3 preferred brand drugs for up to a 3-month supply at standard pharmacies. Standard mail order options also offer a 3-month supply of Tier 1 and Tier 2 drugs with no copay. For higher-tier medications, Tier 4 non-preferred drugs require a $35 copay for a 1-month supply at standard pharmacies. Specialty medications in Tier 5 carry a 33% coinsurance, while Tier 6 supplemental drugs are covered with no copay for a 1-month supply. This plan provides highly competitive coverage with significant savings on everyday medications.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, primary care visits, and preventive services. Outpatient hospital services require a low $25 copay, while emergency room visits carry a $50 copay that is waived upon admission. Skilled nursing facility care is also covered with no copay for the first 20 days, followed by a $50 daily copay for days 21 through 100. In addition to medical care, the plan provides generous dental coverage up to $3,500 and vision eyewear up to $350 annually with no copay or coinsurance. Members also receive a $2,000 yearly allowance for prescription hearing aids and a $115 monthly allowance for over-the-counter items with no copay. Routine hearing exams, home health services, and up to 24 one-way transportation trips per year are also covered at no cost to the member.
Inpatient Hospital See details
Solis Healthy Living Plan (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered, but acute stays do include up to four additional days.
Outpatient Services See details
Solis Healthy Living Plan (HMO) covers outpatient services with no coinsurance, requiring a $25 copay for outpatient hospital and observation services, and no copay for ambulatory surgical center and blood services. Some outpatient substance abuse services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the Solis Healthy Living Plan (HMO) with a copay ranging from no copay to $180 and no coinsurance. Prior authorization and referrals are required for this benefit.
Ambulance and Transportation Services See details
Solis Healthy Living Plan (HMO) offers partially covered ambulance and transportation services, excluding ground ambulance services and transportation to any health-related location. Air ambulance services are covered with a 20% coinsurance and no copay, while up to 24 one-way trips per year to plan-approved locations are covered with no copay and no coinsurance.
Emergency Services See details
Solis Healthy Living Plan (HMO) covers emergency services with a $50 copay and no coinsurance, which is waived if 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 limit with a $50 copay and no coinsurance, but 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 therapy services with no copay and no coinsurance. Chiropractic benefits are partially covered, offering up to 12 routine visits per year while other chiropractic services are not covered, and routine podiatry is covered for up to 12 visits. For mental health and psychiatric specialty services, some services are covered, but individual and group sessions are not covered.
Preventive Services See details
Solis Healthy Living Plan (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. This benefit is partially covered, as it includes health education, fitness, and in-home support, but excludes other services like weight management, nutritional benefits, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by the Solis Healthy Living Plan (HMO) with no copays or coinsurance for annual routine exams, fitting evaluations, and prescription hearing aids up to a $2,000 yearly limit. This benefit is partially covered as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Solis Healthy Living Plan (HMO) vision services are partially covered, featuring one routine eye exam per year with no copay and no coinsurance, while other eye exam services are excluded. Eyewear, including contacts, frames, lenses, and upgrades, is also covered with no copay or coinsurance up to a $350 annual maximum benefit.
Dental Services See details
Dental services are partially covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, up to a maximum annual benefit of $3,500. While many preventive and comprehensive services are covered, this plan does not cover 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, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs have a $35 copay and a 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 access these covered services.
Medical Equipment See details
Medical equipment is partially covered by the Solis Healthy Living Plan (HMO) with no copays, though prior authorization is required and coinsurance ranges from no coinsurance to 20%. While durable medical equipment, prosthetic devices, and diabetic therapeutic shoes are covered, 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 require no copay to a $20 copay with no coinsurance, outpatient x-rays and diagnostic radiological services have no copay, and therapeutic radiological services require a 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. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Solis Healthy Living Plan (HMO) provides coverage for cardiac rehabilitation with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, 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, featuring no copay for days 1 through 20 and a $50 copay per day for days 21 through 100. Prior authorization and referrals are required for these services, and additional days beyond the standard 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 and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, naloxone, and other miscellaneous services are not covered, but eligible members receive a $115 monthly allowance for covered OTC items.
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