A non-government entity
Solis Balanced Plan (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Solis Balanced 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 Balanced Plan (HMO C-SNP) in 2025, please refer to our full plan details page.
Solis Balanced 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 Miami-Dade. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Solis Balanced 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 Balanced 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 Balanced 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 Balanced 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 $2500.00 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:
Sign up for Solis Balanced Plan (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Solis Balanced Plan (HMO C-SNP) has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic and standard generic drugs at the standard pharmacy, and a 25% coinsurance for preferred brand and non-preferred drugs at the standard pharmacy. Specialty tier drugs have a $0 copay at the standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Solis Balanced Plan (HMO C-SNP) offers a wide range of benefits, including coverage for inpatient and outpatient services, emergency care, and primary care with no copay. This plan also covers preventive services, such as hearing and vision care, dental services, and home health services with no copay. Prescription hearing aids are covered up to $2,000 per year, and eyewear is covered up to $350 per year. This plan provides additional benefits such as ambulance services, medical equipment, and dialysis services. It also covers home infusion services and offers an over-the-counter (OTC) allowance of $140 per month. However, some services like cardiac rehabilitation, and additional days beyond Medicare coverage for skilled nursing facilities are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though additional days, non-Medicare covered stays, and upgrades are not covered. Prior authorization and a doctor's referral are required for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are covered, but individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Solis Balanced Plan (HMO C-SNP) and requires prior authorization and a doctor referral. The plan covers this benefit, but does not provide any further information about costs.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Solis Balanced Plan (HMO C-SNP). All ambulance services are covered with a coinsurance, and air ambulance services have a 20% coinsurance, but ground ambulance services are not covered. Transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Solis Balanced Plan (HMO C-SNP) with no copay and no coinsurance. Worldwide Emergency Coverage is covered, but Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Individual and group sessions for Mental Health and Psychiatric services are not covered.
Preventive Services See details
The Solis Balanced Plan (HMO C-SNP) covers preventive services, including annual physical exams, health education, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling (up to 12 visits), fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. 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, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services under the Solis Balanced Plan (HMO C-SNP) include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a maximum plan benefit of $2,000 every year. Prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
The Solis Balanced Plan (HMO C-SNP) covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum of $350 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Solis Balanced Plan (HMO C-SNP) covers dental services, including oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, and other preventive services. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery, with some services limited to a certain number of visits or frequency. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including insulin, are covered under the Solis Balanced Plan (HMO C-SNP), but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for Home Infusion bundled Services and the plan offers step therapy.
Dialysis Services See details
Dialysis Services are covered by the Solis Balanced Plan (HMO C-SNP) with a coinsurance of 20%. Prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment is covered by the Solis Balanced Plan (HMO C-SNP). Durable Medical Equipment (DME) and Prosthetics/Medical Supplies have no copay or coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, Diabetic Therapeutic Shoes/Inserts, and Prosthetic Devices are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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 the covered services.
Home Health Services See details
Home Health Services are covered by the Solis Balanced Plan (HMO C-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Referrals and authorizations are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Solis Balanced Plan (HMO C-SNP). Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization and a doctor's referral, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. This plan covers two days of SNF services per admission or per stay.
Other Services See details
The Solis Balanced Plan (HMO C-SNP) covers acupuncture with prior authorization for up to 24 treatments per year, and over-the-counter (OTC) items with a monthly allowance of $140, including nicotine replacement therapy. The plan also offers a meal benefit for chronic illnesses that requires a doctor's referral. However, services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several others, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved