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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 Orange, Osceola, Seminole. 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.
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) features a $0 drug deductible, allowing your prescription coverage to begin immediately without any upfront out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. Additionally, Tier 6 supplemental drugs are available with no copay for a one-month supply at a standard pharmacy. For brand-name and specialty medications, the plan utilizes a tiered copayment and coinsurance structure at standard pharmacies. Tier 3 preferred brand drugs require a $30 copay for a one-month supply, $60 for a two-month supply, and $85 for a three-month supply. Tier 4 non-preferred drugs have an $80 copay for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Solis Healthy Living Plan (HMO) offers comprehensive healthcare coverage with no copays or coinsurance for primary care, specialist visits, preventive services, and home health care. For inpatient hospital stays, members pay a $50 daily copay for the first five days and no copay for days 6 through 90, with no coinsurance required. Outpatient services also feature no coinsurance, with copayments ranging from no copay for ambulatory surgical centers to an $85 copay for outpatient hospital visits. Supplemental benefits include dental care with no copay or coinsurance up to a $3,000 annual limit, alongside vision and hearing benefits that feature no deductibles, copays, or coinsurance. The plan covers routine eye and hearing exams, while providing up to $250 annually for eyewear and up to $1,000 yearly for prescription hearing aids. Additionally, members benefit from up to 24 free one-way transportation trips per year and a monthly over-the-counter allowance of $115.
Inpatient Hospital See details
Solis Healthy Living Plan (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and both prior authorization and referrals are required.
Outpatient Services See details
Solis Healthy Living Plan (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $40 copay for outpatient substance abuse sessions, a $50 copay per stay for observation services, and an $85 copay for outpatient hospital services. Prior authorization and referrals are required for most of these outpatient services.
Partial Hospitalization See details
Solis Healthy Living Plan (HMO) covers partial hospitalization services with a copayment of either $55.00 or $180.00 and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Solis Healthy Living Plan (HMO), featuring a $200 copay plus coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services (waived if admitted). Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Solis Healthy Living Plan (HMO) covers emergency services with a $100 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum with a $100 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Healthy Living Plan (HMO) covers primary care, specialist, telehealth, and podiatry services with no copay and no coinsurance. Chiropractic services are partially covered with no copay or coinsurance for up to 12 routine visits per year (other chiropractic services are not covered), while therapy, mental health, and opioid treatments are covered with no coinsurance and copays ranging from $10 to $40.
Preventive Services See details
Solis Healthy Living Plan (HMO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Solis Healthy Living Plan (HMO) offers hearing services with no deductible, no copay, and no coinsurance, covering one routine hearing exam and fitting evaluation annually. Prescription hearing aids are partially covered up to a $1,000 yearly limit, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by the Solis Healthy Living Plan (HMO) with no copay, no coinsurance, and no deductible. The plan covers one routine eye exam per year and up to $250 annually for eyewear, including contact lenses and eyeglasses, while other eye exam services are not covered.
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 $3,000 annual maximum. Sub-services that are not covered under this plan include orthodontics, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services.
Home Infusion bundled Services See details
Solis Healthy Living Plan (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Solis Healthy Living Plan (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Solis Healthy Living Plan (HMO) partially covers medical equipment with no copay, requiring prior authorization and coinsurance ranging from no coinsurance up 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. Diagnostic tests have no coinsurance and a copay ranging from no copay up to $90, while radiological services require no copay for diagnostic scans and X-rays, and a 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by the Solis Healthy Living Plan (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Solis Healthy Living Plan (HMO) with no copay and no coinsurance, though prior authorization and referrals are required. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Solis Healthy Living Plan (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $150 daily copay for days 21 through 100. Prior authorization and referrals are required, 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 up to $115 monthly and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture, Naloxone, and other miscellaneous services are not covered under this benefit.
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