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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 2025, 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 & Southern New Hampshire. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $275.00 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 $6750.00 (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 $6750.00 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 has a $275 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies. The plan offers different copays based on the drug tier and the pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Martin's Point Generations Advantage Select (PPO) plan offers a wide array of benefits with varying cost-sharing structures. The plan includes coverage for inpatient hospital stays with copays, outpatient services with copays, and emergency services with copays. The plan also covers primary care with no copay, preventive services with no copay, and vision and dental services with copays and coinsurance. Additional benefits include hearing services, ambulance services, home health services, and medical equipment, each with its own cost-sharing requirements. The plan also covers other services like acupuncture and home infusion services. However, some services like some dental, vision, and hearing services, along with transportation to health-related locations, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-7, and no copay for days 8-90; and for Inpatient Hospital Psychiatric, you will pay a $220 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with a $295 copay, and ambulatory surgical center services with a $225 copay. Outpatient substance abuse services include individual sessions with a $25 copay and group sessions with a $15 copay, but outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Martin's Point Generations Advantage Select (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Martin's Point Generations Advantage Select (PPO). Ground and Air Ambulance Services have a $325 copay and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Martin's Point Generations Advantage Select (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and Worldwide Emergency Transportation has a $325 copay. There is no coinsurance for any of these services.
Primary Care See details
The Martin's Point Generations Advantage Select (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay for routine care, occupational therapy services with a $30 copay, physician specialist services with a $25 copay, and mental health specialty services with a $15-$25 copay depending on the service. It also covers physical therapy and speech-language pathology services with a $30 copay, and additional telehealth benefits with a $0-$30 copay, and opioid treatment program services.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, additional services, kidney disease education services (with prior authorization), and other preventive services. Some services, such as health education, in-home safety assessments, and therapeutic massage, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a $500 maximum benefit per year. Routine hearing exams, prescription hearing aids for the inner, outer, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with 20% coinsurance for contact lenses. Routine eye exams are covered once per year. Eyewear has a combined maximum of $150 per year for both in-network and out-of-network services.
Dental Services See details
Dental services are covered, with a $1,500 maximum benefit per year and a $50 copay for most services. Other diagnostic dental services, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, and oral and maxillofacial surgery have a 50% coinsurance. Oral exams and dental x-rays are covered, but fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0%-20% coinsurance. This benefit requires prior authorization.
Dialysis Services See details
Dialysis Services are covered under the Martin's Point Generations Advantage Select (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Martin's Point Generations Advantage Select (PPO), with some services requiring a doctor referral and prior authorization. Diagnostic Procedures/Tests have a coinsurance of up to 15%, and Lab Services have a $0 copay and coinsurance of up to 20%. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of up to 20%, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by Martin's Point Generations Advantage Select (PPO) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under Martin's Point Generations Advantage Select (PPO), but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services include acupuncture, which is covered with no copay or coinsurance, and over-the-counter (OTC) items with a $50 allowance every three months, including nicotine replacement therapy and Naloxone. Home Infusion Services are covered and require prior authorization and a doctor referral. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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