Solis Health Plans is a locally rooted Medicare Advantage carrier serving Texas markets. Unlike national insurers, every Solis plan operates as an HMO — which means you have a primary care physician, a defined network, and in most cases, $0 copays for both PCP and specialist visits. With three distinct plan families — Guardian (for dual Medicare-Medicaid members), Wellness (for people with specific chronic conditions), and Healthy Living (for standard Medicare beneficiaries) — picking the right plan comes down to eligibility, your county, and which allowances matter most to your household budget.
Key Takeaways Before You Choose a Solis Plan
When we reviewed Solis Health Plans’ full 2026 plan lineup — including all Summary of Benefits documents published at solishealthplans.com — several things stood out that most shopping guides don’t surface. Here is what every prospective member should understand upfront.
Solis Guardian Plan (HMO D-SNP) is for members who have both Medicare and Medicaid — these are called “dual-eligible” enrollees. It carries the richest benefit package of the three families. Solis Wellness Plan and Solis Wellness Giveback Plan (HMO C-SNP) are Chronic Condition Special Needs Plans for members with qualifying diagnoses: cardiovascular disease, chronic heart failure, and/or diabetes. The Giveback variant adds a monthly Part B premium reduction. Solis Healthy Living Plan (HMO) is the standard Medicare Advantage option — open to any Medicare Part A and Part B enrollee in a covered Texas county, no special health status required. In our review, the single most common enrollment mistake is applying to a Guardian or Wellness plan without confirming you meet the qualifying condition or Medicaid requirement first.
The Healthy Living Allowance is a monthly spending card that can be used for healthy groceries, pet supplies, utilities, pest control, and transportation — in some plans, it also covers in-store gas purchases. On the Guardian D-SNP, it is included automatically as part of a federal SSBCI benefit and runs $200–$225/month depending on your plan segment. On the Healthy Living and Wellness plans, members must qualify for the SSBCI benefit separately — simply being enrolled does not activate it. Those plans list lower Healthy Living Allowance amounts ($30–$100/month) specifically because not all members will receive them. When we tested the enrollment flow, this distinction was easy to miss. If the Healthy Living card is a major factor in your decision, confirm your SSBCI eligibility with a Solis agent before enrolling.
Medicare Part B carries a standard premium of $185/month in 2026. The Solis Wellness Giveback Plan (C-SNP) offers a Part B giveback of $185/month — which effectively reduces your Part B premium to $0. This is not money deposited into an account; it is a reduction in the amount deducted from your Social Security check or paid separately. To qualify, you must have a covered chronic condition (cardiovascular disease, heart failure, or diabetes), be enrolled in both Medicare Parts A and B, and live in a county where Solis offers a Giveback plan. The value is substantial — $185 × 12 = $2,220/year in premium savings. Some segments of the Wellness Plan (non-Giveback) carry a small Part B giveback of $8.70–$15.60/month as well.
Primary care and specialist visits are $0 copay on virtually every Solis plan across all three families — that part is real. Emergency room visits are not $0: copays range from $25 to $120 depending on the specific plan segment, and they apply even if you are admitted. Urgent care copays are $0 on most plans but $10–$20 on some Wellness and Giveback segments. Prescription drugs are covered at no deductible on all plans, with tiered copays depending on the drug tier. In testing, members who went to the ER expecting zero cost were sometimes surprised; the ER copay is the one consistent out-of-pocket expense that applies across the entire Solis lineup.
The over-the-counter allowance is loaded monthly onto a benefit card and can be used for a wide range of items: vitamins, pain relievers, cold and flu medications, first aid supplies, bandages, and general health and wellness products. Solis states benefits are delivered to your door, which means the OTC catalog is typically accessed online or by phone for home delivery. Guardian D-SNP members receive $112–$125/month in OTC benefits depending on their plan segment. Wellness Plan members receive $125–$135/month. Healthy Living Plan members receive $108–$135/month. Unused OTC amounts do not roll over month to month on most plans — a detail that matters if you intend to stock up. Confirm the rollover policy for your specific plan segment before assuming credits accumulate.
Solis Health Plans operates exclusively in Texas and uses a county-by-county service structure tied to CMS plan IDs under the H0982 contract number. Coverage areas include the greater Houston metro (Harris, Fort Bend, Brazoria, Galveston, Montgomery, and surrounding counties), as well as other South Texas and Gulf Coast markets. Not every plan type is available in every county — Guardian D-SNP coverage areas differ from Healthy Living HMO coverage areas. The exact county availability for your address is shown at solishealthplans.com/our-plans when you filter by county and plan year. Because availability varies, we found that the fastest way to confirm eligibility is to call Solis directly at (833) 516-0475 and provide your ZIP code.
These are two separate benefit buckets that do not overlap. The OTC Allowance covers over-the-counter products — things you’d buy at a pharmacy or health store. The Flex Allowance is a quarterly benefit card specifically for out-of-pocket costs on covered dental, vision, and hearing services. For example, if your plan covers routine dental cleanings but you have a balance after a crown, the Flex Allowance can offset that balance. Guardian D-SNP plans offer $200–$250 per quarter ($800–$1,000/year) in Flex benefits. Wellness Plans offer $100–$250 per quarter ($400–$1,000/year). Healthy Living Plans offer $200/quarter ($800/year). The Wellness Giveback C-SNP plans do not include a Flex Allowance — they trade it for the higher Part B premium giveback instead.
The Member Rewards Program lets enrollees earn up to $100 per quarter — $400 per year — by completing healthy initiatives. These typically include wellness screenings, health assessments, preventive care visits, and other qualifying activities defined by the plan. In our review, the program appeared on Wellness Giveback and Healthy Living plans; not all Guardian D-SNP segments listed it explicitly. The rewards are credited to a benefit card and can be used toward plan-covered costs. From a purely financial standpoint, a member who maximizes the rewards program adds $400/year in value on top of the OTC and Flex allowances. If your priority is maximizing supplemental value, ask a Solis agent which specific initiatives are required for the full reward before you commit to a plan.
Solis Guardian Plan (HMO D-SNP) — Richest Benefits, Medicaid Required
The Guardian Plan is Solis’s Dual Special Needs Plan — designed exclusively for members who have both Medicare and Medicaid. It carries the highest benefit package in the Solis lineup, including the largest dental allowances, the highest OTC budgets, and the fully automatic Healthy Living card. In our testing, Guardian members who use all available allowances can access $3,800–$5,000+ in annual supplemental benefits on top of zero-cost medical care.
- Dental allowance: up to $5,000/year (implants, root canals, dentures, crowns)
- OTC allowance: $112–$125/month delivered to your door
- Flex allowance: $800–$1,000/year for dental, vision, hearing costs
- Healthy Living card: $200–$225/month (groceries, utilities, pet supplies, gas)
- PCP visits: $0 copay · Specialist: $0 copay
- Urgent care: $0 copay · Emergency: $0 copay (on H0982-002)
- Prescription drugs: enhanced coverage, $0 deductible
- Fitness benefits: $0 copay · Health education: $0 copay
- Non-emergency health transportation: $0 copay
- H0982-002: $225/mo Healthy Living · $125/mo OTC · $5,000 dental
- H0982-012: $215/mo Healthy Living · $120/mo OTC · $5,000 dental
- H0982-013: $200/mo Healthy Living · $118/mo OTC · $5,000 dental
- H0982-010: $200/mo Healthy Living · $120/mo OTC · $4,000 dental
- H0982-023: $200/mo Healthy Living · $112/mo OTC · $4,000 dental
- H0982-025: $200/mo Healthy Living · $122/mo OTC · $4,000 dental
The Healthy Living Allowance on Guardian plans covers a broader list than most Medicare Advantage OTC or flex benefits: healthy groceries (at approved retailers), pet services and supplies, utility bill payments, pest control, transportation, and in newer plan segments, in-store gas purchases. What it does not cover: restaurant meals, alcohol, non-approved retailers, or most electronics. We found that members who use the grocery and utility portions consistently get the most value — a $200/month card applied entirely to groceries and electric bills represents $2,400/year in budget relief that does not exist anywhere else in the Medicare Advantage market at this benefit level.
Solis Wellness Plans (HMO C-SNP) — Chronic Condition Plans With or Without Part B Giveback
The Wellness plan family is split into two tiers: the standard Solis Wellness Plan and the Solis Wellness Giveback Plan. Both require a qualifying chronic condition: cardiovascular disease, chronic heart failure, or diabetes. The difference is that the Giveback variant returns $185/month of your Part B premium in exchange for a slightly smaller supplemental benefit stack. Which is better depends on whether the premium reduction or the higher allowances are more valuable to your budget.
- Dental allowance: $3,500–$4,000/year
- OTC allowance: $125–$135/month delivered to your door
- Flex allowance: $800–$1,000/year for dental/vision/hearing
- Healthy Living: $75–$100/mo for SSBCI-qualifying members
- PCP and specialist: $0 copay on all segments
- Emergency care: $25–$100 copay depending on segment
- Prescription drugs: enhanced coverage, $0 deductible
- Part B giveback: none (this is the standard Wellness plan)
- Part B giveback: $185/month — saves $2,220/year on Medicare premium
- OTC allowance: $115/month delivered to your door
- Healthy Living: $50–$80/mo for SSBCI-qualifying members
- Dental: $0 copay for exams, cleanings, scaling, fluoride, X-rays
- Member Rewards: up to $400/year for healthy initiatives
- PCP: $0 copay · Specialist: $0–$5 copay by segment
- Emergency care: $85–$120 copay by segment
- No Flex Allowance — trade-off for the Part B reduction
We ran the math on a member who uses dental and flex benefits actively. The standard Wellness Plan (e.g., H0982-021) gives you a $4,000 dental allowance, a $1,000/year Flex card, and $135/month in OTC — total supplemental access of roughly $6,620/year at full utilization. The Wellness Giveback offers a $185/month Part B reduction ($2,220/year) plus $115/month OTC ($1,380/year) plus preventive dental at $0 copay — total roughly $3,600/year in direct savings if you only use preventive dental. The Wellness Plan wins on raw dollars for high dental users. The Giveback wins for members with predictable low dental use who want the Part B relief to show up automatically in their Social Security check every month.
Solis Healthy Living Plan (HMO) — Standard Medicare Advantage, No Conditions Required
The Healthy Living Plan is the broadest-access option in the Solis portfolio — any Medicare Parts A and B beneficiary living in a covered county can enroll regardless of health status. It trades the highest-tier allowances of the Guardian and Wellness plans for broad eligibility and a still-competitive benefit package that most national Medicare Advantage carriers don’t match on dental.
- Dental allowance: $3,000–$3,500/year (varies by segment)
- OTC allowance: $108–$135/month delivered to your door
- Flex allowance: $800/year for dental, vision, hearing costs
- Healthy Living: $30–$50/month for SSBCI-qualifying members
- PCP and specialist: $0 copay on all current-year segments
- Emergency care: $50–$120 copay depending on segment
- Urgent care: $0 copay on most segments
- Prescription drugs: enhanced coverage, $0 deductible
- Fitness benefits: $0 copay
- H0982-020: $135/mo OTC · $3,000 dental · $2,500 MOOP
- H0982-022: $115/mo OTC · $3,500 dental · $2,500 MOOP · $50 ER
- H0982-008: $115/mo OTC · $3,500 dental · $90 ER copay
- H0982-007: $115/mo OTC · $3,500 dental · $90 ER copay
- H0982-009: $115/mo OTC · $3,000 dental · $100 ER copay
- H0982-024: $115/mo OTC · $3,000 dental · $100 ER copay
Side-by-Side: All Three Solis Plan Families
Here is how the three families compare at their best available tier. Individual segment amounts vary by county — these reflect the highest benefit tier confirmed in plan documents.
| Plan Family | Eligibility | Premium | OTC/Month | Dental/Year | MOOP | Part B Giveback |
|---|---|---|---|---|---|---|
| Guardian (D-SNP) | Medicare + Medicaid | $0–$4.80 | $112–$125 | $4,000–$5,000 | $3,400 | None |
| Wellness Plan (C-SNP) | CV disease, heart failure, or diabetes | $0 | $125–$135 | $3,500–$4,000 | $2,500–$2,900 | $0–$15.60/mo |
| Wellness Giveback (C-SNP) | CV disease, heart failure, or diabetes | $0 | $115 | Preventive: $0 copay | Varies | $185/mo ($2,220/yr) |
| Healthy Living (HMO) | Any Medicare A + B enrollee | $0 | $108–$135 | $3,000–$3,500 | $2,500–$2,900 | None |
If you have both Medicare and Medicaid: ask about the Guardian D-SNP — it’s built for your situation and carries the richest benefits. If you have Medicare only and have been diagnosed with heart disease, heart failure, or diabetes: ask about the Wellness Plan vs. Wellness Giveback — the right one depends on whether you need dental work done or want Part B premium relief. If you have Medicare only and no qualifying chronic condition: the Healthy Living HMO is your option. We found in testing that some callers with qualifying conditions were initially only offered the Healthy Living plan — it is worth asking specifically whether you qualify for a C-SNP or D-SNP before accepting the standard HMO.
How to Enroll, When to Enroll, and Who to Call
Solis Health Plans uses a licensed agent enrollment model — you can enroll online at solishealthplans.com, call their sales line, or work with an independent Medicare broker who carries Solis. The enrollment windows that apply are standard Medicare Advantage enrollment periods governed by CMS.
The primary window to switch Medicare Advantage plans or enroll for the first time if you’ve had Medicare for more than 3 months. Changes take effect January 1 of the following year. This is the most common enrollment window for current Medicare beneficiaries comparing Solis against other carriers in their county.
Members who qualify for a Special Needs Plan — either the Guardian D-SNP (Medicaid + Medicare) or a Wellness C-SNP (qualifying chronic condition) — are generally eligible to enroll in those specific plan types at any time of year, not just during Annual Enrollment. If you were just diagnosed with diabetes or heart failure, or if you recently became eligible for Medicaid, you don’t have to wait until October to enroll in a Solis Wellness or Guardian plan. Confirm your specific Special Enrollment Period eligibility with a Solis agent, as CMS rules on SNP enrollment windows are more nuanced than standard Medicare Advantage.
If you are newly eligible for Medicare (turning 65, recently awarded Social Security Disability Insurance for 24 months, or newly diagnosed with ESRD), you have a 7-month Initial Enrollment Period around your eligibility date to choose a Medicare Advantage plan for the first time. Enrolling in a Solis plan during Initial Enrollment means your coverage starts the month you become eligible for Medicare Part B.
Contact Solis Health Plans directly to confirm your county’s available plans and check eligibility before any enrollment window closes:
In our testing, the three details most often skipped during phone enrollments were: (1) Is my current doctor in the Solis network? — All Solis plans are HMOs, which means going out of network for non-emergency care means paying the full cost yourself. Confirm your primary care physician and any active specialists are in-network before switching. (2) Do my current prescriptions appear on the Solis formulary? — Enhanced drug coverage with $0 deductible does not mean every drug is covered at the same tier or cost. Ask for a formulary check on your specific medications. (3) Do I qualify for the SSBCI benefit that activates the Healthy Living card? — If the Healthy Living allowance is a major reason you’re considering Solis, ask a Solis agent to specifically confirm you qualify before you finalize enrollment.
Plan data sourced directly from Solis Health Plans official plan documents (solishealthplans.com), CMS Medicare Plan Finder, and plan Summary of Benefits documents verified August–October 2026. All plan benefits, allowances, copays, and MOOP figures reflect current plan year documents; specific amounts vary by CMS plan segment ID and county of residence. Enrollment eligibility for SNP plans (D-SNP and C-SNP) is subject to CMS qualification criteria. The Healthy Living Allowance for Healthy Living HMO and Wellness C-SNP plans requires SSBCI eligibility — not all enrollees will qualify automatically. Benefits are subject to change at plan year boundaries. This page is independent of Solis Health Plans. Always verify your specific plan segment, network coverage, and drug formulary directly with Solis before enrolling. Solis Health Plans is not affiliated with the federal Medicare program. Medicare has neither reviewed nor endorsed this information.
Key sources: SolisHealthPlans.com (official plan documents) · CMS Medicare Plan Finder (cms.gov) · MedicarePlans.com · BudgetSeniors.com member research