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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 Miami-Dade. 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. During the initial coverage phase, you will pay a $0 copay for standard generic and specialty tier drugs at a standard pharmacy, and a $10 copay for preferred brand drugs. Non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. Please note that if you qualify for the low-income subsidy, your premium may be reduced.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers comprehensive coverage, including inpatient and outpatient services with varying copays, as well as emergency and preventive services. This plan also includes additional benefits like hearing, vision, and dental services, with specific limits and copays for each. Additional benefits include transportation to health-related locations, hearing exams, and prescription hearing aids up to $2,000 annually, as well as routine eye exams and eyewear. The plan also covers dental services up to $3,500 per year, and offers other services like acupuncture and over-the-counter items with monthly limits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute are covered for 3 days per benefit period.
Outpatient Services See details
Outpatient Services are covered by the Solis Healthy Living Plan (HMO), including all Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a $25 copay, while Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Healthy Living Plan (HMO), but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The Solis Healthy Living Plan (HMO) covers ambulance and transportation services, including services not usually covered by Medicare plans. Air ambulance services have a 20% coinsurance, while ground ambulance services are not covered. Transportation services to plan-approved health-related locations are covered with no copay or coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Solis Healthy Living Plan (HMO). Emergency services have a $50 copay, and there is no coinsurance. Worldwide Emergency Coverage also has a $50 copay, and there is no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Healthy Living Plan (HMO) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental health specialty services, individual sessions for psychiatric services, and group sessions for psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, an annual physical exam, additional preventive services, kidney disease education services, and other preventive services. Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and In-Home Support Services are also covered. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the Solis Healthy Living Plan (HMO), including routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance; prescription hearing aids are covered up to $2000 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $350.00 per year.
Dental Services See details
The Solis Healthy Living Plan (HMO) offers dental coverage with a $3,500 annual maximum. Oral exams, other diagnostic services, prophylaxis (cleaning), fluoride treatments, other preventive services, and oral and maxillofacial surgery are covered. Dental X-rays are limited to one every three years, while restorative services, periodontics, prosthodontics (removable and fixed), and implant services are limited to one visit, and maxillofacial prosthetics and orthodontics are not covered.
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 between 0% and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Solis Healthy Living Plan (HMO), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Solis Healthy Living Plan (HMO). Durable Medical Equipment (DME) has a coinsurance between 0% and 20% and requires prior authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit and Prosthetic Devices are covered with coinsurance, while Medical Supplies are not covered. Diabetic Equipment is covered, but Diabetic Supplies are not covered; Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $35, Therapeutic Radiological Services have a maximum copay of $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Solis Healthy Living Plan (HMO), with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Solis Healthy Living Plan (HMO). There is no copay for days 1-20, and a $50 copay for days 21-100.
Other Services See details
The Solis Healthy Living Plan (HMO) covers acupuncture with a limit of 24 treatments per year, and requires prior authorization. This plan also provides over-the-counter (OTC) items with a maximum benefit coverage amount of $110.00 every month, and covers nicotine replacement therapy. Meal benefits are covered with a doctor referral, and are for a chronic illness. The following services are not covered: Dual Eligible SNPs with Highly Integrated Services, 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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