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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 2026, 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 3.5 out of 5 stars in 2026.
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 $4.80. 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 $615.00 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) features an annual prescription drug deductible of $615. For those looking to save on medications, this plan offers no copay for Tier 1 preferred generic and Tier 2 generic drugs at standard pharmacies for one-month, two-month, and three-month supplies. Additionally, you will pay no copay for a three-month supply of these generic medications when using standard mail order services. For higher-tier medications, the plan requires a 25 percent coinsurance at standard pharmacies for Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty tier drugs. Furthermore, Tier 6 supplemental drugs are covered with no copay for a one-month supply at standard pharmacies. This structured drug coverage helps beneficiaries understand their out-of-pocket costs for both routine and specialized medications.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers robust coverage with no copays and no coinsurance for most essential medical services. This includes inpatient hospital stays, outpatient services, primary care, specialist visits, emergency care, and skilled nursing facility stays. For specialized treatments, dialysis services require a 20% coinsurance, while partial hospitalization may carry up to a $180 copay depending on the service. Beyond core medical care, this plan provides valuable supplemental benefits with no copays or coinsurance, including comprehensive dental up to $4,000 annually, a $2,000 hearing aid allowance, and a $350 yearly vision benefit. Members also benefit from unlimited one-way transportation to plan-approved locations, a monthly $112 over-the-counter allowance, and home health services.
Inpatient Hospital See details
Solis Guardian Plan (HMO D-SNP) provides partially covered inpatient hospital services, featuring no copay and no coinsurance for covered acute and psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit, and prior authorization and referrals are required.
Outpatient Services See details
Outpatient services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. While some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Solis Guardian Plan (HMO D-SNP), requiring prior authorization and a referral. Depending on the service, you will pay either no copay or a $180 copay, with no coinsurance.
Ambulance and Transportation Services See details
Solis Guardian Plan (HMO D-SNP) partially covers ambulance and transportation services, offering unlimited one-way trips to plan-approved locations with no copay and no coinsurance. Air ambulance services are covered with a 20% coinsurance and no copay under prior authorization, while ground ambulance services and transportation to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance for both emergency and urgently needed services. Worldwide emergency services are partially covered up to a $75,000 maximum benefit with no copay or coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary care services under the Solis Guardian Plan (HMO D-SNP) are covered with no copay and no coinsurance, including specialist visits, physical therapy, occupational therapy, and telehealth. Routine chiropractic and routine podiatry services are partially covered for up to 12 visits per year with no copay and no coinsurance, though individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, although referrals are required for certain screenings and exams. This benefit is partially covered because sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, including an annual routine exam and fitting evaluation. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, but inner ear, outer ear, and over the ear models are not covered, and over-the-counter (OTC) hearing aids are excluded.
Vision Services See details
Vision services are partially covered by the Solis Guardian Plan (HMO D-SNP), with other eye exam services not covered. Covered benefits, which include one routine eye exam annually and eyewear up to a $350 yearly limit, feature no copay and no coinsurance.
Dental Services See details
Dental Services are partially covered under the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance up to a maximum annual benefit of $4,000. While many preventive and comprehensive services are included, other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Solis Guardian Plan (HMO D-SNP) partially covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs are covered with no copay or coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis services are covered under the Solis Guardian Plan (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these services.
Medical Equipment See details
Solis Guardian Plan (HMO D-SNP) partially covers medical equipment, offering Durable Medical Equipment (DME) with no copay and no coinsurance, subject to prior authorization. While some equipment services are covered, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance. While some services are covered, specific sub-services including diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Solis Guardian Plan (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, although prior authorization and a referral are required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Solis Guardian Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. Admission is allowed without a prior three-day inpatient hospital stay, but additional days beyond Medicare-covered limits are not covered.
Other Services See details
Solis Guardian Plan (HMO D-SNP) offers partial coverage for other services, featuring a monthly over-the-counter allowance of up to $112 and chronic illness meal benefits with a referral, both with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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