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Martin's Point Generations Advantage Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Martin's Point Generations Advantage Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Martin's Point Generations Advantage Select (PPO) in 2026, please refer to our full plan details page.
Martin's Point Generations Advantage Select (PPO) is a PPO plan offered by Martin's Point Health Care, Inc. available for enrollment in 2025 to people living in Southern Maine. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Martin's Point Generations Advantage Select (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Martin's Point Generations Advantage Select (PPO).
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 Martin's Point Generations Advantage Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $104.00. 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 a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Martin's Point Generations Advantage Select (PPO) plan features a $300 drug deductible. You can enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs when using a preferred pharmacy or standard mail order. For Tier 2 generic drugs, copays start as low as $5 at preferred pharmacies, while standard pharmacies charge a $10 copay for a one-month supply. Higher-tier medications are subject to coinsurance, with Tier 3 preferred brands costing 25% coinsurance across all pharmacy options. Tier 4 non-preferred drugs require 30% coinsurance at preferred pharmacies and 32% at standard pharmacies, while Tier 5 specialty drugs carry a 29% coinsurance for a one-month supply.
Additional Benefits
The Martin's Point Generations Advantage Select (PPO) plan offers comprehensive coverage for core medical needs, featuring primary care provider visits and home health services with no copay. Inpatient hospital stays require a $350 daily copay for the first five days before dropping to no copay, while emergency care has a $115 copay that is waived upon admission. Outpatient services and specialist visits are also covered with predictable copays and no coinsurance. Additionally, the plan provides partial coverage for dental care up to a $1,000 annual maximum and prescription hearing aids up to $500 per ear with no copay. Routine eye exams are covered with a $0 to $25 copay, and durable medical equipment is available with no copay or coinsurance. These benefits are designed to minimize your out-of-pocket expenses for both routine and specialized healthcare services.
Inpatient Hospital See details
Martin's Point Generations Advantage Select (PPO) covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care stays require a $350 daily copay for days 1 through 5 (with no copay for days 6 through 90 and unlimited additional days), while psychiatric stays require a $220 daily copay for days 1 through 7 (with no copay for days 8 through 90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Martin's Point Generations Advantage Select (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital services, $300 per stay for observation services, and $250 for ambulatory surgical center services. Outpatient substance abuse services require a $15 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Martin's Point Generations Advantage Select (PPO) covers partial hospitalization services with a $70 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Martin's Point Generations Advantage Select (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Martin's Point Generations Advantage Select (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered up to a $25,000 maximum benefit with no coinsurance and copays ranging from $115 to $325.
Primary Care See details
Primary care benefits under Martin's Point Generations Advantage Select (PPO) feature no copay and no coinsurance for primary care provider visits. Specialist visits require a $25 copay and no coinsurance, physical and occupational therapies require a $30 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under Martin's Point Generations Advantage Select (PPO) are partially covered with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness programs. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, therapeutic massage, and counseling services.
Hearing Services See details
Martin's Point Generations Advantage Select (PPO) provides partial coverage for hearing services, offering fitting and evaluation exams for a $25 copay and no coinsurance, while routine hearing exams are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to $500 per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Martin's Point Generations Advantage Select (PPO) partially covers vision services, as other eye exam services are not covered. Routine eye exams are covered once annually with a $0 to $25 copay and no coinsurance, while eyewear is covered with no copay and a 20% coinsurance for contact lenses, up to a $150 combined annual limit.
Dental Services See details
Dental services are partially covered by Martin's Point Generations Advantage Select (PPO), which features a $1,000 annual maximum benefit and a $25 copay with no coinsurance for Medicare-covered dental. Most other covered dental services require a $50 copay and either no coinsurance or 50% coinsurance, but fluoride treatment, adjunctive general services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Martin's Point Generations Advantage Select (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Martin's Point Generations Advantage Select (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Martin's Point Generations Advantage Select (PPO) covers durable medical equipment and diabetic equipment with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered. Prosthetic devices and medical supplies are covered with no copay and a 20% coinsurance, with prior authorization required for some items.
Diagnostic and Radiological Services See details
Martin's Point Generations Advantage Select (PPO) partially covers diagnostic and radiological services, requiring prior authorization and referrals, while outpatient X-ray services are not covered. Covered lab services have no copay and no coinsurance, diagnostic tests require a copay with no coinsurance, and diagnostic and therapeutic radiological services have a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered by Martin's Point Generations Advantage Select (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Martin's Point Generations Advantage Select (PPO) plan. None of the sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by this plan.
Skilled Nursing Facility (SNF) See details
Martin's Point Generations Advantage Select (PPO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and feature no coinsurance, with no copay for days 1 through 20 and a $175 daily copay for days 21 through 100.
Other Services See details
Martin's Point Generations Advantage Select (PPO) offers partial coverage for other services, providing acupuncture, home infusion services, and over-the-counter items with no copay and no coinsurance. Meal benefits are not covered under this plan.
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