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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 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 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. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through a standard three-month mail order. Additionally, there is no copay for a one-month supply of Tier 6 supplemental drugs at standard pharmacies. For brand-name and specialty medications, the plan charges a 25% coinsurance at standard pharmacies. This 25% coinsurance applies to Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs.
Additional Benefits
The Solis Guardian Plan (HMO D-SNP) offers comprehensive healthcare coverage with no copays and no coinsurance for major services, including inpatient hospital stays, outpatient care, and primary doctor visits. While there are no deductibles for many covered services, members will pay a 20% coinsurance for dialysis and air ambulance services, and copays up to $180 for partial hospitalization. This plan also includes valuable extra benefits with no copay, such as a $4,000 annual dental allowance, a $350 eyewear limit, and a $1,000 yearly benefit for prescription hearing aids. Additionally, members receive unlimited transportation to approved medical locations and a $122 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Solis Guardian Plan (HMO D-SNP) offers inpatient acute and psychiatric hospital coverage with no copay and no coinsurance, subject to referral and prior authorization requirements. This benefit is partially covered, as additional days, non-Medicare-covered stays, and acute hospital upgrades are not covered.
Outpatient Services See details
Solis Guardian Plan (HMO D-SNP) covers outpatient services with no copay and no coinsurance, including outpatient hospital, ambulatory surgical center, and outpatient blood services with no deductible. Outpatient substance abuse services are partially covered under this plan, as individual and group sessions are not covered.
Partial Hospitalization See details
The Solis Guardian Plan (HMO D-SNP) covers partial hospitalization with no coinsurance and copays ranging from no copay up to $180. Prior authorization and a referral are required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under the Solis Guardian Plan (HMO D-SNP), as ground ambulance services and transportation to any health-related location are not covered. Air ambulance services are covered with a 20% coinsurance and no copay, while unlimited one-way transportation to plan-approved health-related locations is available with no copay and no coinsurance.
Emergency Services See details
Solis Guardian Plan (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum with no copay or coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Guardian Plan (HMO D-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. Chiropractic services are partially covered, with other chiropractic services not covered, while mental health and psychiatric specialty services have some services covered, but individual and group sessions are not covered.
Preventive Services See details
Solis Guardian Plan (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams and kidney disease education. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, tobacco cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Solis Guardian Plan (HMO D-SNP) covers hearing services with no copay and no coinsurance for annual routine hearing exams and fitting evaluations. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,000 yearly limit, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Solis Guardian Plan (HMO D-SNP) provides partially covered vision services with no copay and no coinsurance, though other eye exam services are not covered. This plan covers one routine eye exam per year and offers up to a $350 annual allowance for eyewear, including contact lenses and eyeglasses, with no deductible.
Dental Services See details
Dental Services are partially covered by the Solis Guardian Plan (HMO D-SNP) with no copay and no coinsurance up to a maximum annual benefit of $4,000. While most preventive and comprehensive services are covered, other diagnostic dental services, other preventive dental 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, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with no copay or coinsurance, while Medicare Part B chemotherapy or radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Solis Guardian Plan (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Solis Guardian Plan (HMO D-SNP) covers medical equipment with no copay and no coinsurance, subject to prior authorization. Durable medical equipment is covered through preferred vendors, but for non-Medicare prosthetics, medical supplies, and diabetic equipment, only some services are covered as prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Solis Guardian Plan (HMO D-SNP) partially covers diagnostic and radiological services with no copay and no coinsurance, although referrals and prior authorizations are required. Under this benefit, diagnostic procedures or tests, lab services, outpatient X-rays, and both diagnostic and therapeutic radiological services are not covered.
Home Health Services See details
Solis Guardian Plan (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Solis Guardian Plan (HMO D-SNP) covers some Cardiac Rehabilitation Services 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 Guardian Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization and referrals are required. This benefit is partially covered, as additional days beyond Medicare-covered SNF days are not covered by the plan.
Other Services See details
Solis Guardian Plan (HMO D-SNP) covers select other services with no copay and no coinsurance, including a meal benefit for chronic illness with a referral and up to $122 monthly for over-the-counter (OTC) items. Acupuncture and other additional services are not covered under this plan.
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