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Solis Wellness Plan (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Wellness Plan (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Solis Wellness Plan (HMO C-SNP) in 2026, please refer to our full plan details page.
Solis Wellness Plan (HMO C-SNP) is a HMO C-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 Wellness Plan (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Solis Wellness Plan (HMO C-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 Wellness Plan (HMO C-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 Wellness Plan (HMO C-SNP), 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 Wellness Plan (HMO C-SNP) features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic medications at standard pharmacies, which also applies to three-month standard mail orders. Additionally, Tier 6 supplemental drugs are available with no copay for a one-month supply at standard pharmacies. For higher-tier prescriptions, costs vary depending on the tier and supply duration at standard pharmacies. Tier 3 preferred brand drugs require a $25 copay for a one-month supply, $50 for two months, and $70 for three months. Tier 4 non-preferred drugs carry a $75 copay for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers robust coverage with no copays or coinsurance for primary care, specialist visits, telehealth, and preventive care. For hospital stays, members pay a $30 daily copay for the first five days of inpatient care and no copay for days six through 90, while outpatient hospital services require an $85 copay. Emergency room visits have a $100 copay, which is waived if admitted, while urgently needed services and routine transportation of up to 48 one-way trips require no copay. This plan also features excellent supplemental benefits, including no copays or coinsurance for dental services up to a $3,500 annual limit, routine vision exams with a $250 eyewear allowance, and hearing exams with a $1,000 hearing aid allowance. Additionally, members can take advantage of a $125 monthly over-the-counter allowance and home health services with no copay. Most medical equipment and Part B drugs carry a 0% to 20% coinsurance, while diagnostic x-rays are available with no copay.
Inpatient Hospital See details
Solis Wellness Plan (HMO C-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $30 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though up to 2 additional acute stay days are allowed.
Outpatient Services See details
Solis Wellness Plan (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services for an $85 copay, observation services for a $50 copay per stay, and substance abuse sessions for a $40 copay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Solis Wellness Plan (HMO C-SNP) with a copay of $55.00 or $180.00 and no coinsurance. Prior authorization and a referral are required for these services.
Ambulance and Transportation Services See details
Solis Wellness Plan (HMO C-SNP) covers ground ambulance services with a $200 copay and air ambulance services with a 20% coinsurance (waived if admitted), with prior authorization required. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Solis Wellness Plan (HMO C-SNP) covers emergency services with a $100 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services are covered with no copay or coinsurance. Worldwide emergency services are partially covered up to a $75,000 maximum benefit with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Wellness Plan (HMO C-SNP) provides primary care, specialist, podiatry, and telehealth services with no copays and no coinsurance. Therapy, psychiatric, and opioid treatment services require copays ranging from $10 to $40 with no coinsurance, while chiropractic care is partially covered with no copay for up to 12 routine visits per year.
Preventive Services See details
Solis Wellness Plan (HMO C-SNP) provides partially covered preventive services with no copay and no coinsurance, though referrals are required for some covered services like annual physical exams and kidney disease education. However, the plan does not cover in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety devices, or counseling.
Hearing Services See details
Hearing services are partially covered by Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to a $1,000 annual maximum with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services under the Solis Wellness Plan (HMO C-SNP) are partially covered with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and a $250 annual maximum for eyewear like contacts and glasses, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by the Solis Wellness Plan (HMO C-SNP), offering no copay and no coinsurance for covered services up to a $3,500 annual maximum. While many preventive and comprehensive treatments are included, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Solis Wellness Plan (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Solis Wellness Plan (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is covered by the Solis Wellness Plan (HMO C-SNP) with no copay, though prior authorization is required. Durable medical equipment has a 0% to 20% coinsurance, while prosthetics and diabetic equipment are partially covered with a 20% coinsurance and no coinsurance respectively, as medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Solis Wellness Plan (HMO C-SNP) partially covers diagnostic and radiological services, as lab services are not covered by the plan. Covered diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $90, while diagnostic radiological and outpatient X-ray services have no copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Solis Wellness Plan (HMO C-SNP) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Solis Wellness Plan (HMO C-SNP) feature no copay and no coinsurance, meaning some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Solis Wellness Plan (HMO C-SNP) 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 coverage does not extend to additional days beyond the standard 100 days.
Other Services See details
Solis Wellness Plan (HMO C-SNP) partially covers Other Services, providing a meal benefit for chronic illnesses and a $125 monthly over-the-counter (OTC) allowance with no copay and no coinsurance. A referral is required for the meal benefit, while acupuncture is not covered under this plan.
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