Solis Healthy Living Plan (HMO)
Available to residents of Palm Beach County, FL for 2026. Contract H0982, plan 008, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Palm Beach County
- Plan website
- Browse the Solis Healthy Living Plan (HMO) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $2,900.00? |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO? |
| Contract / plan | H0982-008-0 |
| Offered by | Solis Health Plans |
| Parent organization | Athena Healthcare Holdings, LLC |
| Formulary drugs | 3,539 |
| Formulary exception tier | 4? |
| Pharmacy search | solishealthplans.com |
| Member services | (844)447-6547TTY 711 |
CMS star ratings
- Overall
- 4.5 out of 5 stars for Overall
- Health plan (Part C)
- 4 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H0982 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay(referral required) |
| Other health care professional | $0 copay(referral required) |
| Additional telehealth services | $0 copay(referral required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay(referral required) |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay(referral required) |
| Diabetes self-management training | $0 copay(referral required) |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$50 copay(referral required) |
| Lab services | $0 copay(referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$75 copay(authorization and referral required) |
| Therapeutic radiology | 20% coinsurance(authorization and referral required) |
| Outpatient x-rays | $0–$50 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $90 copay |
| Urgent care | $0 copay |
| Worldwide emergency coverage | $90 copay · $75,000 plan limit |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $50 per day for days 1–10; $0 per day for days 11–90(authorization and referral required) |
| Outpatient hospital services | $75 copay(authorization and referral required) |
| Outpatient observation | $50 copay(authorization and referral required) |
| Ambulatory surgical center | $0 copay(authorization and referral required) |
| Outpatient blood services | $0 copay(authorization and referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $125 per day for days 21–100(authorization and referral required) |
| Home health care | $0 copay(authorization and referral required) |
| Kidney dialysis | 20% coinsurance(authorization and referral required) |
| Rehabilitation | |
| Occupational therapy | $0–$20 copay(referral required) |
| Physical therapy and speech-language therapy | $0–$20 copay(authorization and referral required) |
| Cardiac rehabilitation | $25 copay(authorization and referral required) |
| Pulmonary rehabilitation | $20 copay(authorization and referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $50 per day for days 1–10; $0 per day for days 11–90(authorization and referral required) |
| Outpatient mental health, individual session | $20 copay(referral required) |
| Outpatient mental health, group session | $20 copay(referral required) |
| Psychiatrist, individual session | $20 copay(referral required) |
| Psychiatrist, group session | $20 copay(referral required) |
| Partial hospitalization | $55 copay(authorization and referral required) |
| Intensive outpatient program | $180 copay(authorization and referral required) |
| Outpatient substance use, individual session | $40 copay(referral required) |
| Outpatient substance use, group session | $40 copay(referral required) |
| Opioid treatment program | $40 copay(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $200 copay(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay(limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 0%–20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | $0 copay(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay(referral required) |
| Routine chiropractic care | $0 copay(referral required, limits apply) |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $0 copay(referral required) |
| Routine foot care | $0 copay(referral required, limits apply) |
| Dental? | |
| Medicare-covered dental services | $0 copay(authorization and referral required) |
| Preventive dental plan limit | $3,500 plan limit every year |
| Oral exams | $0 copay |
| Cleanings | $0 copay |
| Fluoride treatment | $0 copay |
| Dental x-rays | $0 copay |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | $0 copay(authorization required) |
| Endodontics (root canals) | $0 copay(authorization required) |
| Periodontics (gum disease) | $0 copay(authorization required) |
| Dentures and other removable prosthodontics | $0 copay |
| Maxillofacial prosthetics | Not covered |
| Implants | $0 copay(authorization required) |
| Bridges and other fixed prosthodontics | $0 copay(authorization required) |
| Oral and maxillofacial surgery | $0 copay(authorization required) |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay(authorization required) |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay(referral required) |
| Routine eye exam | $0 copay(referral required, limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(authorization and referral required, limits apply) |
| Eyewear plan limit | $250 plan limit every year |
| Contact lenses | $0 copay(authorization and referral required, limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(authorization and referral required, limits apply) |
| Eyeglass lenses | $0 copay(authorization and referral required, limits apply) |
| Eyeglass frames | $0 copay(authorization and referral required, limits apply) |
| Eyewear upgrades | $0 copay(authorization and referral required, limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay(referral required) |
| Routine hearing exam | $0 copay(referral required, limits apply) |
| Hearing aid fitting and evaluation | $0 copay(referral required, limits apply) |
| Hearing aid plan limit | $1,500 plan limit every year |
| Hearing aids (all types) | $0 copay(authorization and referral required, limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $115 allowance every month |
| Meals after a hospital stay or for a chronic condition | $0 copay(referral required) |
| Fitness benefit | $0 copay |
| Health education | $0 copay |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | $0 copay |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | $20.00 |
| Tier 4 | $75.00 |
| Tier 5 | 33% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $20.00 | $20.00 | n/a | $55.00 | $55.00 | n/a |
| Tier 4: Non-Preferred Drug | $75.00 | $75.00 | n/a | n/a | n/a | n/a |
| Tier 5: Specialty Tier | 33% | 33% | n/a | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Benefits in plain text
Solis Healthy Living Plan (HMO) (H0982-008-0) is a 2026 HMO Medicare Advantage plan offered by Solis Health Plans, available to residents of Palm Beach County, FL.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $2,900.00.
The drug deductible is $0.00.
The plan's formulary lists 3,539 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: $20.00; tier 4: $75.00; tier 5: 33%; tier 6: $0.00.
CMS gives the plan's contract (H0982) an overall rating of 4.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.