A non-government entity
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:
Sign up for Martin's Point Generations Advantage Access (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Martin's Point Generations Advantage Access (PPO) plan has a $200 deductible for prescription drugs. Once you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 20% coinsurance at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D 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 includes coverage for primary care, preventive, hearing, vision, and dental services with copays, coinsurance, and annual limits. Emergency services, ambulance, and home health services are also covered, but some services like certain dental, hearing, and vision services are not included.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay 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 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 Outpatient Hospital Services with a copay between $0 and $395, Observation Services with a $395 copay, Ambulatory Surgical Center (ASC) Services with a $295 copay, and Individual and Group Sessions for Outpatient Substance Abuse with a copay between $25 and $25. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the plan and requires prior authorization, with a copay of $70.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Martin's Point Generations Advantage Access (PPO). Ground and Air Ambulance Services each have a $325 copay, with no coinsurance, but 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 under this plan. For Emergency Services, there is a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and no coinsurance, and Worldwide Emergency Transportation has a $325 copay and no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a copay of $0-$5, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a copay of $25, Physical Therapy and Speech-Language Pathology Services with a $30 copay, and Additional Telehealth Benefits with a copay of $0-$45; however, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services, including Annual Physical Exams, are covered by Martin's Point Generations Advantage Access (PPO). Additional services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a plan-specified amount of $500 per year, but routine hearing exams, inner ear hearing aids, outer ear hearing aids, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$45, and eyewear with 20% coinsurance. The plan covers routine eye exams once per year, and also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. The plan offers a combined maximum benefit of $150 per year for all eyewear.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services and Other Dental Services with a $50 copay. Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Oral and Maxillofacial Surgery, and Other Preventive Dental Services are covered with a $50 copay and 50% coinsurance. Fluoride Treatment, Adjunctive General Services, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Martin's Point Generations Advantage Access (PPO) plan. This includes coverage for Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Martin's Point Generations Advantage Access (PPO), with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under Martin's Point Generations Advantage Access (PPO), with a 20% coinsurance for Durable Medical Equipment, Medicare-covered Prosthetic Devices, and Medical Supplies, and no copay. Some services are covered, but 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, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a coinsurance of at most 15%, and Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a coinsurance of at most 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 prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the Martin's Point Generations Advantage Access (PPO) plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Martin's Point Generations Advantage Access (PPO) plan. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered 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 covers over-the-counter (OTC) items up to $50 every three months, including nicotine replacement therapy and naloxone. Other services such as meal benefits, home infusion services, and additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved