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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 Orange, Osceola, Seminole. 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. During the initial coverage phase, after you meet your deductible, you will pay 25% coinsurance for most drugs, with the exception of specialty tier drugs, which have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium will be $20.30.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive coverage with a focus on preventative and outpatient care. Many services, including ambulance, emergency, and home health services, have no copay. You can also expect coverage for primary care, hearing, vision, and dental services, with specific annual maximums or limits. This plan includes coverage for inpatient and outpatient services, but requires prior authorization and a doctor's referral for many services. There is also coverage for home infusion, dialysis, medical equipment, and diagnostic services. However, some services like non-Medicare-covered stays, and certain types of hearing aids and dental services, are not included.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but additional days for each, non-Medicare-covered stays, and upgrades are not covered. Prior authorization and a doctor's referral are required for both.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services, are covered, but Individual and Group Sessions for Outpatient Substance Abuse are not covered. Outpatient Blood Services include an enhanced benefit, waiving the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Guardian Plan (HMO D-SNP), but requires prior authorization and a doctor referral. There is no information available about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Solis Guardian Plan (HMO D-SNP), with no copay or coinsurance for all ambulance services, but ground and air ambulance services are not covered. Transportation Services to a plan-approved health-related location are covered with no copay or 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 or coinsurance. Worldwide Emergency Coverage is covered under the plan, with no copay or coinsurance. 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 healthcare professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental health specialty services are partially covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, are covered by the Solis Guardian Plan (HMO D-SNP), with no copay. Additional services like Health Education, Nutritional/Dietary Benefit, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, and other preventive services are covered. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, including hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered up to $1,000 every year, but inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are also not covered.
Vision Services See details
The Solis Guardian Plan (HMO D-SNP) covers vision services including routine eye exams once per year, and eyewear with a combined maximum benefit of $350 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. A doctor referral is required for eye exams and eyewear.
Dental Services See details
The Solis Guardian Plan (HMO D-SNP) covers dental services, with a maximum benefit of $4,000 per year. The plan covers oral exams, dental x-rays (1 every three years), other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Orthodontic services are covered under Diagnostic and Preventive Dental, and some services require prior authorization and a doctor's referral.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan covers Medicare Part B Insulin Drugs, but does not cover Medicare Part B Chemotherapy/Radiation Drugs.
Dialysis Services See details
Dialysis Services are covered under the Solis Guardian Plan (HMO D-SNP), with prior authorization and a doctor referral required. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Solis Guardian Plan (HMO D-SNP) covers Durable Medical Equipment (DME) and Prosthetics/Medical Supplies with no copay or coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Solis Guardian Plan (HMO D-SNP), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for covered services.
Home Health Services See details
Home Health Services are covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance, but 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 generally covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's 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 and non-Medicare-covered stays are not covered. A doctor referral and prior authorization are required, 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. Over-the-counter (OTC) items are covered up to $125.00 every month, including nicotine replacement therapy, and a meal benefit is covered with a doctor's referral. 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 are not covered.
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