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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 2026 to people living in Northeastern ME. 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 $49.00. 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 $450.00 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 $12500.00 (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 $12500.00 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 $450 annual prescription drug deductible. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay when using a preferred pharmacy or standard mail order. Standard pharmacies charge copays starting at $4 for Tier 1 and Tier 6 drugs, and $10 for Tier 2 drugs. Higher-tier medications require coinsurance rather than flat copays. Tier 3 preferred brands carry a 25% coinsurance, while Tier 4 non-preferred drugs require 30% to 32% coinsurance depending on your pharmacy choice. Specialty drugs in Tier 5 are covered with a 27% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
Martins Point Generations Advantage Select PPO offers robust medical coverage featuring no copays and no coinsurance for primary care doctor visits, preventive services, and home health care. For hospital stays, members pay daily copays for the first five days of inpatient care with no coinsurance, followed by no copay for subsequent days. Outpatient services, specialist visits, and emergency care are also covered with predictable flat copayments and no coinsurance. This plan provides essential coverage for dental, vision, and hearing services, including no-copay preventive dental cleanings and up to $500 annually per ear for eligible hearing aids. Vision exams are covered with low-to-no copays, while diagnostic services, dialysis, and durable medical equipment typically require coinsurance up to 20%. Additionally, members receive a quarterly over-the-counter item allowance with no copay or coinsurance.
Inpatient Hospital See details
Martin's Point Generations Advantage Select (PPO) covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays require a $350 copayment for days 1 to 5 and no copayment for days 6 and beyond, while psychiatric stays require a $275 copayment for days 1 to 5 and no copayment for days 6 to 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 a $0 to $350 copay for outpatient hospital services, a $350 copay per stay for observation services, and a $325 copay for ambulatory surgical center services. Outpatient substance abuse services carry a copay of $10 for group or $25 for individual sessions, while outpatient blood services have no copay and no coinsurance.
Partial Hospitalization See details
Martin's Point Generations Advantage Select (PPO) covers partial hospitalization with a $75.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Martin's Point Generations Advantage Select (PPO) plan, featuring a $325 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. However, transportation services to plan-approved or health-related locations are not covered.
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 $30 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency services are also covered up to a $25,000 maximum benefit limit with no coinsurance and copays of $115 for emergency or urgent care and $325 for emergency transportation.
Primary Care See details
Martin's Point Generations Advantage Select (PPO) features primary care doctor visits and opioid treatment with no copay and no coinsurance, while specialist visits require a $40 copay and therapy services require a $30 copay, both with no coinsurance. Mental health and psychiatric services have a $10 to $25 copay with no coinsurance, but podiatry and routine chiropractic care are not covered by the plan.
Preventive Services See details
Preventive Services are partially covered by Martin's Point Generations Advantage Select (PPO) with no copay and no coinsurance for services like annual physical exams, kidney disease education, and glaucoma screenings. While fitness benefits, remote access, and chemotherapy-related wigs (up to $350 lifetime) are covered, other supplemental benefits such as health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Martin's Point Generations Advantage Select (PPO), excluding routine hearing exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids. Diagnostic exams require a $40 copay and no coinsurance with no deductible, while eligible prescription hearing aids are covered with no copay, no coinsurance, and no deductible up to a maximum limit of $500 per ear every year.
Vision Services See details
Vision services are partially covered by Martin's Point Generations Advantage Select (PPO), as other eye exam services are not covered. Routine eye exams are covered once per year with a $0 to $40 copay and no coinsurance, while eligible eyewear features no copay and 20% coinsurance for contact lenses up to a $100 annual maximum.
Dental Services See details
Martin's Point Generations Advantage Select (PPO) provides partially covered dental services up to a $500 annual limit, excluding fluoride, adjunctive general, implant, and orthodontic services. Medicare-covered dental services require a $40 copay and no coinsurance, preventive services like exams and cleanings have no copay and no coinsurance, and comprehensive services require a $50 copay and 50% coinsurance.
Home Infusion bundled Services See details
Martin's Point Generations Advantage Select (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and carry a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Martin's Point Generations Advantage Select (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Martin's Point Generations Advantage Select (PPO) covers medical equipment with no copay, featuring a 20% coinsurance for durable medical equipment and prosthetics, and no coinsurance for diabetic equipment. This benefit is partially covered, as diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Martin's Point Generations Advantage Select (PPO), requiring prior authorization and referrals. Lab services feature no copay and no coinsurance, outpatient x-rays require a $25 copay plus coinsurance, and diagnostic radiological services require both a copay and a minimum 15% coinsurance.
Home Health Services See details
Martin's Point Generations Advantage Select (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Martin's Point Generations Advantage Select (PPO) with no copay and no coinsurance, although prior authorization is required. While some services are covered, specific sub-services such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Martin's Point Generations Advantage Select (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $175 daily copay for days 21 through 100. Prior authorization is required, and a three-day prior hospital stay is not required, though additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Martin's Point Generations Advantage Select (PPO) provides partially covered Other Services, which include home infusion services and over-the-counter (OTC) items with no copay and no coinsurance, up to a $25 limit every three months. Acupuncture and meal benefits are not covered under this plan.
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