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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 2026, 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 3.5 out of 5 stars in 2026.
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 $3.00. 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:
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Drug Coverage
The Solis Balanced Plan (HMO C-SNP) features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 3 (Preferred Brand) drugs filled for up to a 3-month supply at standard pharmacies. Additionally, standard mail order delivery offers no copay for a 3-month supply of Tier 1 and Tier 2 medications. For higher-tier medications, Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) prescriptions require a 25% coinsurance for a 1-month supply at standard pharmacies. Tier 6 (Supplemental Drugs) are also highly accessible, carrying no copay for a 1-month supply at standard pharmacies. This budget-friendly structure ensures low-cost access to essential generic and brand-name medications.
Additional Benefits
The Solis Balanced Plan (HMO C-SNP) offers comprehensive healthcare coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary and specialist care, emergency services, and home health care. Patients can also benefit from preventive care, skilled nursing facility stays, and outpatient services without worrying about copays or coinsurance. While most medical services are covered at no cost, some specialized treatments like dialysis and certain durable medical equipment require a twenty percent coinsurance. This plan also features robust supplemental benefits, including dental coverage up to a thirty-five hundred dollar annual limit and routine hearing exams with a two thousand dollar hearing aid allowance, both with no copays or coinsurance. Additionally, members receive a three hundred fifty dollar annual eyewear allowance, up to forty-eight one-way transportation trips per year, and a one hundred forty dollar monthly allowance for over-the-counter items. These extensive additional benefits help minimize out-of-pocket expenses while ensuring access to vital daily health resources.
Inpatient Hospital See details
Inpatient hospital services are covered by the Solis Balanced Plan (HMO C-SNP) with no copay and no coinsurance for both acute and psychiatric stays, though prior authorization and referrals are required. This benefit is partially covered because while up to four additional days for acute stays are included, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Solis Balanced Plan (HMO C-SNP) are covered with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. For outpatient substance abuse, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Solis Balanced Plan (HMO C-SNP) with no coinsurance and copays ranging from no copay up to $180. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Solis Balanced Plan (HMO C-SNP) partially covers ambulance and transportation services, offering air ambulance coverage with a 20% coinsurance and no copay, while ground ambulance services are not covered. Transportation services are also partially covered, providing up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Solis Balanced Plan (HMO C-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency services are also covered with no copay and no coinsurance up to a $75,000 maximum, although this benefit is only partially covered as worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Solis Balanced Plan (HMO C-SNP) provides primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. Routine chiropractic and podiatry services are partially covered for up to 12 visits per year, while mental health specialty and psychiatric services are covered but do not include individual or group sessions.
Preventive Services See details
Preventive services under the Solis Balanced Plan (HMO C-SNP) are partially covered with no copay and no coinsurance, though some services require a referral. Covered benefits include annual physicals, health education, and fitness benefits, while sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Solis Balanced Plan (HMO C-SNP) covers routine hearing exams and fitting evaluations annually with no copay, no deductible, and no coinsurance. Prescription hearing aids are also covered with no copay or coinsurance up to a $2,000 annual limit, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Solis Balanced Plan (HMO C-SNP) offers partially covered vision services with no deductible, no copay, and no coinsurance. Covered benefits include one routine eye exam per year and up to a $350 annual limit for eyewear, including contact lenses and frames, while other eye exam services are not covered.
Dental Services See details
Solis Balanced Plan (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance up to an annual maximum benefit of $3,500. While many preventive and comprehensive dental services are covered, this plan does not cover other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered by the Solis Balanced Plan (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. While insulin is covered with no copay and no coinsurance under this benefit, Medicare Part B chemotherapy or radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Solis Balanced 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 partially covered by the Solis Balanced Plan (HMO C-SNP) with no copays, though prior authorization is required. Durable medical equipment incurs between no coinsurance and 20% coinsurance, and prosthetic devices and diabetic therapeutic shoes carry a 20% coinsurance, while medical supplies and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Solis Balanced Plan (HMO C-SNP) offers diagnostic and radiological services with no coinsurance, though lab services are not covered under this benefit. Covered diagnostic procedures and tests require a copay of $0 to $20, while diagnostic radiological, therapeutic radiological, and outpatient X-ray services are covered with no copay.
Home Health Services See details
Home Health Services are covered by the Solis Balanced Plan (HMO C-SNP) with no copay and no coinsurance. Patients should note that both a referral and prior authorization are required to access these services.
Cardiac Rehabilitation Services See details
Solis Balanced Plan (HMO C-SNP) provides some covered cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Solis Balanced Plan (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, though the plan does allow admission without requiring a prior three-day inpatient hospital stay.
Other Services See details
Solis Balanced Plan (HMO C-SNP) partially covers other services, offering chronic illness meal benefits and over-the-counter items up to $140 monthly with no copay and no coinsurance. Acupuncture and Naloxone OTC coverage are not covered under this plan.
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