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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 Orange, Osceola, Seminole. 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 $2900.00 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. In the initial coverage phase, you will pay different copays depending on the drug tier. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, $20 for standard generic drugs, $75 for preferred brand drugs, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have reduced premiums.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers a variety of benefits with varying costs. Inpatient hospital stays have a $50 copay for days 1-5, with no copay for days 6-90, while outpatient services have copays ranging from $40 to $85 depending on the service. Emergency services have a $100 copay, which is waived if admitted to the hospital within 24 hours. This plan also includes coverage for primary care, preventive services, hearing, vision, and dental. Hearing exams and hearing aids have no copay, and vision services include routine eye exams and eyewear. Dental services have a $3,000 annual maximum benefit. Other benefits include ambulance services, home health, skilled nursing, and more, with specific costs and limitations for each service.
Inpatient Hospital See details
Inpatient Hospital is covered, with a $50 copay for days 1-5 and no copay for days 6-90. Additional days and non-Medicare-covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a $85 copay, and Observation Services have a $50 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40 and $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Healthy Living Plan (HMO) with a $55 copay, and requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Solis Healthy Living Plan (HMO), with a $200 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation Services to any health-related location are not covered, but transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services are covered under the Solis Healthy Living Plan (HMO), with a $100 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours. Worldwide Emergency Coverage has a $100 copay and no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered. Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
The Solis Healthy Living Plan (HMO) covers Primary Care services, including Primary Care Physician Services, Chiropractic Services (with a doctor referral), Occupational Therapy Services (with a $10-$40 copay), Physician Specialist Services (with a doctor referral), Mental Health Specialty Services (with a $20 copay for individual and group sessions and a doctor referral), Podiatry Services (including Routine Foot Care), Other Health Care Professional, Psychiatric Services (with a $20 copay for individual and group sessions and a doctor referral), Physical Therapy and Speech-Language Pathology Services (with a $10-$40 copay and a doctor referral and authorization), Additional Telehealth Benefits, and Opioid Treatment Program Services (with a $40 copay and a doctor referral and prior authorization).
Preventive Services See details
Preventive services, including Medicare-covered services, are covered under the Solis Healthy Living Plan (HMO). The plan also covers additional preventive services, such as 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, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. 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 include routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance, and prescription hearing aids with a maximum plan benefit of $1,000 every year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Solis Healthy Living Plan (HMO) covers vision services, including routine eye exams once per year, with no deductible. Eyewear is covered with a combined maximum benefit of $250 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Solis Healthy Living Plan (HMO) offers dental services with a maximum benefit of $3,000 per year. Oral exams, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery are covered, while dental x-rays are limited to one every three years. Restorative services, periodontics, prosthodontics (removable and fixed), and implant services are covered with limited visits, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you pay a $35 copay and between 0% and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you 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 is covered by the Solis Healthy Living Plan (HMO), including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered medical supplies, but Durable Medical Equipment for use outside the home and Medical Supplies are not covered. Additionally, Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $90, and outpatient x-ray services with no copay. Therapeutic Radiological Services have a 20% coinsurance, and Lab Services are not covered.
Home Health Services See details
Home Health Services are covered under the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, but prior 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 covered, but none of the sub-services are covered. Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Solis Healthy Living Plan (HMO), but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
The Solis Healthy Living Plan (HMO) covers acupuncture with prior authorization, and up to 24 treatments per year. Over-the-counter (OTC) items are covered with a maximum benefit of $88.00 per month, and the plan offers Nicotine Replacement Therapy (NRT). Meal benefits are covered with a doctor referral, and the meals are for a chronic illness.
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