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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 2025, 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 4 out of 5 stars in 2025.
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) has an enhanced alternative drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs and specialty tier drugs at a standard pharmacy. Standard generic drugs have a $15 copay, preferred brand drugs have a $75 copay, and non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Solis Wellness Plan (HMO C-SNP) offers comprehensive coverage, including inpatient and outpatient hospital services, primary care, and preventive services. Many services have a copay, such as outpatient hospital services ($85), emergency services ($75), and mental health services ($20), while other services have no copay, such as routine eye exams, home health services, and hearing exams. This plan also provides additional benefits like hearing aids up to $1000 per year, a $3,500 annual dental maximum, and an OTC items benefit of up to $114.00 per month. Other benefits include ambulance services with a copay or coinsurance, and a $200 copay for ground ambulance services, and 20% coinsurance for air ambulance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5, there is a $30 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Solis Wellness Plan (HMO C-SNP) with an $85 copay for outpatient hospital services and a $50 copay for observation services, in addition to coverage for ambulatory surgical center services, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services. Prior authorization and a doctor referral are required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Solis Wellness Plan (HMO C-SNP) with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Solis Wellness Plan (HMO C-SNP). Ground ambulance services have a $200 copay, and air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location are covered, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Solis Wellness Plan (HMO C-SNP). Emergency Services and Worldwide Emergency Coverage have a $75 copay, while Urgently Needed Services have no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Solis Wellness Plan (HMO C-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy and physical therapy services have a copay between $10 and $40. Individual and group sessions for mental health and psychiatric services have a $20 copay, while opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, additional preventive services, health education, nutritional/dietary benefits, 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. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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. In-home support services are covered.
Hearing Services See details
Hearing Services are covered by the Solis Wellness Plan (HMO C-SNP), including routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) with no copay up to a maximum of $1000 per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Solis Wellness Plan (HMO C-SNP) covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum benefit of $250 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Solis Wellness Plan (HMO C-SNP) offers dental services with a maximum plan benefit of $3,500 per year. Oral exams, other diagnostic dental 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, and restorative services, periodontics, prosthodontics (removable and fixed), and implant services are limited to one visit within a specific time frame. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Solis Wellness Plan (HMO C-SNP). There is a coinsurance for this benefit, but the exact amount is not specified in the provided information.
Dialysis Services See details
Dialysis Services are covered by the Solis Wellness Plan (HMO C-SNP), requiring prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetic Devices with a 20% coinsurance; however, Durable Medical Equipment for use outside the home, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Solis Wellness Plan (HMO C-SNP), including diagnostic procedures and tests with a copay of up to $90, and diagnostic radiological services with a copay of up to $90. Therapeutic radiological services have a 20% coinsurance, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Solis Wellness Plan (HMO C-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Solis Wellness Plan (HMO C-SNP), with a doctor referral and prior authorization required. There is no copay for days 1-20, and a $150 copay for days 21-100.
Other Services See details
The Solis Wellness Plan (HMO C-SNP) covers acupuncture with prior authorization, up to 24 treatments per year. This plan also offers an Over-the-Counter (OTC) items benefit, providing up to $114.00 per month, including Nicotine Replacement Therapy (NRT), but not Naloxone. The plan also includes a meal benefit with prior authorization and a doctor referral. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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