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Martin's Point Generations Advantage Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Martin's Point Generations Advantage Access (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 Access (PPO) in 2025, please refer to our full plan details page.
Martin's Point Generations Advantage Access (PPO) is a PPO plan offered by Martin's Point Health Care, Inc. available for enrollment in 2025 to people living in 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 Access (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 Access (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 Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $200.00 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 $9550.00 (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 $9550.00 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 Access (PPO) plan has a $200 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll have no copay at preferred pharmacies, and a $10 copay at standard and mail order pharmacies. For other tiers, you will pay coinsurance that varies by drug type and pharmacy. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Martin's Point Generations Advantage Access (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. The plan also includes coverage for ambulance, emergency, and primary care services. Additional benefits include hearing, vision, and dental care, with specific copays and coinsurance for each service. The plan also covers home health, medical equipment, and diagnostic services with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $400 copay for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a $220 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $225 copay, and Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Martin's Point Generations Advantage Access (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 Access (PPO). Both ground and air ambulance services have a $325 copay, and there is 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 Martin's Point Generations Advantage Access (PPO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Emergency Transportation has a $325 copay, and Urgently Needed Services has a $55 copay. There is no coinsurance for these services.
Primary Care See details
Primary Care physician services have a copay between $0 and $10, chiropractic services have a $15 copay, and occupational therapy services have a $30 copay. Physician specialist services have a $45 copay, individual and group mental health sessions have a $25 copay, physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, and additional preventive services; however, health education, in-home safety assessments, personal emergency response systems, therapeutic massage, adult day health services, post discharge in-home medication reconciliation, re-admission prevention, home and bathroom safety devices and modifications, counseling services, enhanced disease management, telemonitoring services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling are not covered. The plan also covers wigs for hair loss related to chemotherapy (up to a $350 lifetime maximum benefit), weight management programs, alternative therapies, medical nutrition therapy, nutritional/dietary benefits, fitness benefits, kidney disease education services (prior authorization required), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and remote access technologies.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, and fitting/evaluation for hearing aids with unlimited visits in the first year of purchase. Prescription hearing aids are covered up to a maximum of $500 per year, but Routine Hearing Exams, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with 20% coinsurance for contact lenses, with a combined maximum benefit of $150 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include Medicare Dental Services and Other Dental Services, each with a $50 copay. Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are covered, with some limitations on the number of visits or X-Rays per year. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are covered with a $50 copay and 50% coinsurance, while Fluoride Treatment and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Martin's Point Generations Advantage Access (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by Martin's Point Generations Advantage Access (PPO), with a 20% coinsurance for Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of the covered services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Martin's Point Generations Advantage Access (PPO) plan. Diagnostic Procedures/Tests have a coinsurance of up to 15%, while Lab Services have no copay and a coinsurance of up to 20%. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have a coinsurance of up to 15%.
Home Health Services See details
Home Health Services are covered by Martin's Point Generations Advantage Access (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, 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 are not covered.
Other Services See details
The Martin's Point Generations Advantage Access (PPO) plan covers acupuncture with no copay, and also covers over-the-counter (OTC) items up to $50 every three months. Several other services are not covered, including meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others.
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