Solis Health Plans

What Solis Health Plans does

Solis Health Plans, Inc. is a privately held Medicare Advantage HMO plan sponsor founded in 2015 and headquartered in Doral, Florida. The company operates under an HMO Medicare contract and a Florida Medicaid D-SNP contract, and is NCQA-accredited. Solis serves two primary segments: dual-eligible Medicare/Medicaid beneficiaries through its D-SNP product (Solis Guardian Plan) and individuals with chronic conditions such as cardiovascular disease, chronic heart failure, and diabetes through its C-SNP product (Solis Wellness Giveback Plan). The company holds a CMS service area license across 11 Florida counties spanning South Florida (Miami-Dade, Broward, Palm Beach) and Central Florida (Hillsborough, Pasco, Pinellas, Polk, Orange, Osceola, Seminole).

Solis's core technology is a Medicare Advantage HMO/D-SNP/C-SNP plan administration platform with an integrated member portal (solismemberportal.com), real-time pharmacy benefit tools powered by Navitus, electronic prior authorization via Cover My Meds, OTC fulfillment through SunScripts, and a utilization management department that applies InterQual, MCG, and Hayes clinical criteria for coverage decisions. The company layers a Quality Improvement Program compliant with 42 CFR §422.152, including HEDIS measurement and STARS reporting. Member-facing services include a Medication Therapy Management program (in partnership with Aprexis Health Solutions since January 2024), Member Rewards (up to $400/year), Over-the-Counter monthly allowances ($112-$125), and PAPA in-home companionship.

Solis generates revenue primarily through CMS capitation payments (per-enrollee per-month premiums) for Medicare Advantage Part C and Part D coverage, with member cost-sharing and Part D subsidies as secondary streams. Premiums range from $0 to $4.80 monthly for D-SNP plans and $0 with Part B giveback of up to $185/month for C-SNP plans. The company distributes through certified in-house Sales Associates conducting in-person appointments, an inside sales call center (844-447-6547), licensed agent/broker partnerships, and self-service enrollment via the CMS Medicare Online Enrollment Center. Leadership includes CEO Efrain Duarte, COO Michael Lynch, and CMO Francisco Omar Hernandez. The company is privately held with no disclosed external investors, parent company, or revenue figures.

Name

Solis Health Plans

Legal name

Solis Health Plans, Inc.

Website

https://solishealthplans.com

Company type

Private

Founded year

2015

Operating status

Operating

Headcount range

51–100 employees

Short description

Solis Health Plans is a Florida-based Medicare Advantage HMO offering D-SNP plans for dual-eligible Medicare/Medicaid beneficiaries and C-SNP plans for individuals with chronic conditions across 11 Florida counties, with CMS capitation as its primary revenue source.

Ownership category

akta.pro rank

Product category

Medicare Advantage Insurance

NAICS

Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Accident & Health Insurance (6321)

akta.pro primary industry

D-SNP Plan Sponsorship & Benefit Design (HLAEAFAA)

akta.pro secondary industries

D-SNP Care Management (Medical) (HLAEAFAC), D-SNP Quality, Stars, HEDIS & Compliance (HLAEAFAJ), D-SNP Supplemental Benefits & Flex Card/OTC Administration (HLAEAFAN), D-SNP Utilization Management & Prior Authorization (HLAEAFAM)

Keywords

• Medicare Advantage plans
• Special Needs Plans
• Dual-eligible coverage
• Medicare health insurance
• Prescription drug plans

Headquarters

HQ city

Doral

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Marketing or Sales, Infrastructure, Technology or R&D

Revenue model

1. Medicare Advantage Premiums (Part C): CMS pays per-enrollee per-month premiums to Solis as a Medicare Advantage HMO plan sponsor. Premium revenue is risk-adjusted based on the health status and demographics of enrolled members (risk adjustment model per CMS).
2. Medicare Part D (Prescription Drug) Revenue: Solis generates revenue through Medicare Part D prescription drug coverage, with CMS subsidies and member cost-sharing for covered medications. Includes mail-order pharmacy partnerships (Express Scripts, Walgreens Mail, Amazon Pharmacy).

Pricing tiers

Go-to-market motion4 records

Distribution channels4 records

Marketing channels7 records

Core offering

Solis Health Plans is a Florida-based Medicare Advantage HMO organization that administers Dual-Eligible Special Needs Plans (D-SNP) for individuals with Medicare and Medicaid and Chronic Condition Special Needs Plans (C-SNP) for individuals with cardiovascular disease, chronic heart failure, or diabetes. The plans combine Medicare Part A, B, and D coverage with supplemental benefits such as dental, vision, hearing, OTC allowances, transportation, healthy living allowances, and care management, operating across 11 Florida counties.

Product overview

Solis Health Plans is a Medicare Advantage organization offering a portfolio of Special Needs Plans (SNPs) including Dual-Eligible Special Needs Plans (D-SNP) for those with Medicare and Medicaid, and Chronic Special Needs Plans (C-SNP) for individuals with cardiovascular diseases, chronic heart failure, and/or diabetes. The product portfolio centers on the Solis Guardian Plan (D-SNP) and Solis Wellness Giveback Plan (C-SNP), both HMO products (Plan H0982 series) providing comprehensive Medicare Advantage benefits that exceed Original Medicare. Supporting the core plans are member-facing services including a Member Portal, Medication Therapy Management (MTM) Program, Over-the-Counter (OTC) Benefit, Member Rewards Program, Case Management, and Social Services. Provider-facing services include Provider Resources, Pharmacy tools, Utilization Management, and Compliance & Quality programs. All plans include Part D prescription drug coverage through a network pharmacy that includes mail order options via Express Scripts, Walgreens Mail, and Amazon Pharmacy.

Differentiator

Problem solved

Functional benefit

Products and services

• Solis Guardian Plan (HMO D-SNP) Dual-Eligible Special Needs Plan (HMO D-SNP, Plan H0982) for individuals with both Medicare and Medicaid. Provides Medicare Part A, B, and D coverage plus supplemental benefits including dental ($4,000–$5,000/yr), vision, hearing, OTC allowance ($112–$120/mo), transportation, Flex Allowance ($200/quarter), and Healthy Living allowance.
• Solis Wellness Giveback Plan (HMO C-SNP) Chronic Condition Special Needs Plan (HMO C-SNP, Plan H0982) for individuals with cardiovascular disease, chronic heart failure, or diabetes. Features $0 monthly premium, Part B premium giveback, reduced specialist copays, OTC allowance, and SSBCI Healthy Living allowance.
• Solis Member Portal

Quantifiable outcome

• Up to $400 per year in Member Rewards for completing health screenings and wellness activities ($100 per quarter)
• +3 more outcomes

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

Feature4 records

Partnerships

Five partnerships are on record, tiered core.

• Aprexis Health SolutionscoreTechnology or Integration · 1 January 2024Beginning January 2024, Solis partnered with Aprexis Health Solutions to deliver Medication Therapy Management (MTM) to qualified Medicare members with complex health needs. Aprexis provides targeted medication reviews, comprehensive medication reviews conducted by pharmacists, and medication action plans at no additional cost to eligible members.
• Navitus Health Solutions (via MyPrime)coreTechnology or IntegrationSolis uses Navitus-powered tools including Real-Time Benefit Check (RTBC) and MyPrime online portals for coverage determination requests, prior authorization, step therapy information, and medication lookup. Members and providers can access these tools through solismemberportal.com.
• SunScriptscoreTechnology or IntegrationSunScripts is Solis's OTC fulfillment partner, managing over-the-counter product ordering and home delivery. Members call 833-898-7046 to place OTC orders, with delivery within 5–7 business days.
• Express Scripts, Walgreens Mail, Amazon PharmacycoreTechnology or IntegrationSolis offers mail-order pharmacy through three providers—Express Scripts, Walgreens Mail, and Amazon Pharmacy—giving members options for home delivery of maintenance medications.
• LightHouse ServicescoreImplementation/ SI/ Consulting PartnerLightHouse Services provides Solis's compliance hotline (833-720-0006, available 24/7) and fraud reporting platform, enabling anonymous reporting of compliance violations, ethics concerns, or suspected fraud. Reports can also be submitted via email ([email protected]) or fax (215-689-3885).

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Molina Healthcare: Molina operates government-sponsored health plans including Medicare Advantage and D-SNPs, with a similar focus on low-income and dual-eligible populations and overlapping Florida service areas.
• Alignment Health: Alignment Health is a tech-enabled MA insurer focused on senior and SNP plans in select states; its SNP-centric model and California-focused operating approach are highly comparable to Solis's smaller-scale D-SNP/C-SNP focus.
• Simply Healthcare (a Centene company): Simply Healthcare is a Florida-focused Medicaid and Medicare plan owned by Centene, directly competing with Solis for dual-eligible and MA members in Florida.
• CarePlus Health Plans (Humana): CarePlus is a Humana subsidiary focused exclusively on Florida Medicare Advantage beneficiaries, making it the most direct regional competitor to Solis in shared counties.
• Florida Blue (GuideWell): Florida Blue is the state's Blue Cross Blue Shield licensee offering Medicare Advantage and D-SNP products; as a home-market incumbent, it competes head-on with Solis across overlapping Florida counties.

Broad incumbents

• CVS Health (Aetna Medicare): Aetna, part of CVS Health, offers MA and D-SNP plans nationally with strong pharmacy integration, overlapping Florida service areas and competing for the same dual-eligible beneficiaries.
• UnitedHealthcare (AARP Medicare): UnitedHealthcare is the largest overall MA insurer and a top D-SNP sponsor, directly competing with Solis for dual-eligible and chronic-condition members across Florida counties.
• Elevance Health (Anthem Blue Cross Blue Shield): Elevance offers MA plans including D-SNPs across many states and competes with Solis in Florida for dual-eligible and chronically ill members via Anthem-branded plans.
• Humana: Humana is the largest Medicare Advantage carrier and a major D-SNP and C-SNP sponsor nationally, with deep Florida penetration. It is the most consequential competitor in Solis's geography and product lines.
• Centene (Wellcare): Centene's Wellcare Medicare brand is a major D-SNP and MA carrier with strong government-program focus, directly competing with Solis for dual-eligible members in Florida.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/solishealthplans
• LinkedInlinkedin.com/company/28599697
• Instagraminstagram.com/solishealthplans

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Solis Health Plans