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Solis Guardian Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Guardian Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Guardian Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
Solis Guardian Plan (HMO D-SNP) is a HMO D-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 Guardian Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Solis Guardian Plan (HMO D-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 Guardian Plan (HMO D-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 Guardian Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 Guardian Plan (HMO D-SNP) has a $590 deductible for prescription drugs. After the deductible, you'll pay coinsurance for your prescriptions, with the amount depending on the drug tier and pharmacy. For example, you'll pay 25% coinsurance for drugs in tiers 1-4 at a standard pharmacy. For those who qualify for the low-income subsidy (LIS), the monthly premium is $20.30. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers a wide range of benefits with varying cost structures. Many services, including emergency services, primary care, preventive services, hearing exams, and medical equipment, come with no copay. Vision services, including eye exams and eyewear, are covered with a combined maximum benefit of $350 per year, while dental services have a maximum benefit of $4,000 per year. The plan also covers inpatient and outpatient services, home health services, and skilled nursing facilities, but may require prior authorization or doctor referrals. Dialysis services require prior authorization and have a 20% coinsurance. Additionally, the plan provides coverage for acupuncture, OTC items up to $125 per month, and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization and a doctor referral. Additional days, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Guardian Plan (HMO D-SNP), but requires both prior authorization and a doctor referral. There is no information about the cost of this service in the provided snippet.
Ambulance and Transportation Services See details
The Solis Guardian Plan (HMO D-SNP) covers ambulance and transportation services, but ground and air ambulance services are not covered. Transportation services to a plan-approved health-related location are covered with no copay and no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, but Worldwide Emergency Services has a maximum plan benefit coverage of $75,000. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Guardian Plan (HMO D-SNP) 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 that include individual and group sessions are not covered.
Preventive Services See details
The Solis Guardian Plan (HMO D-SNP) covers various preventive services, including Medicare-covered services with no copay, annual physical exams, 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. Some services, like In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others, are not covered.
Hearing Services See details
The Solis Guardian Plan (HMO D-SNP) covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no copay, as well as prescription hearing aids up to $2,000 per year. However, prescription hearing aids for the inner ear, outer ear, and over-the-ear hearing aids, and OTC hearing aids, are not covered.
Vision Services See details
The Solis Guardian Plan (HMO D-SNP) covers vision services including routine eye exams (1 per year), contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $350 per year.
Dental Services See details
The Solis Guardian Plan (HMO D-SNP) offers dental services, with a maximum benefit of $4,000 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 certain timeframe. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Solis Guardian Plan (HMO D-SNP), with prior authorization required. Insulin benefits, including Medicare Part B Insulin Drugs, are covered under this plan. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Solis Guardian Plan (HMO D-SNP), but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Solis Guardian Plan (HMO D-SNP). Durable Medical Equipment (DME) and Prosthetics/Medical Supplies have no copay or coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Solis Guardian Plan (HMO D-SNP) covers diagnostic and radiological services, but does not cover diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, or outpatient X-ray services. There is no copay for diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Solis Guardian Plan (HMO D-SNP), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice; Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor's referral are required for SNF services, and the plan covers two days per admission or per stay.
Other Services See details
The Solis Guardian Plan (HMO D-SNP) covers acupuncture with a limit of 24 treatments per year and requires prior authorization, as well as over-the-counter (OTC) items with a maximum benefit of $125.00 per month, including nicotine replacement therapy, but does not cover Naloxone coverage. The plan also offers a meal benefit for chronic illness with a doctor referral. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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