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Martin's Point Generations Advantage Alliance (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Martin's Point Generations Advantage Alliance (HMO). 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 Alliance (HMO) in 2025, please refer to our full plan details page.
Martin's Point Generations Advantage Alliance (HMO) is a HMO plan offered by Martin's Point Health Care, Inc. available for enrollment in 2025 to people living in All Maine & NH Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Martin's Point Generations Advantage Alliance (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Martin's Point Generations Advantage Alliance (HMO).
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 Alliance (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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
Prescription drugs are not covered by Martin's Point Generations Advantage Alliance (HMO).
Additional Benefits
The Martin's Point Generations Advantage Alliance (HMO) plan provides coverage for a variety of services, including inpatient and outpatient hospital care, with varying copays. Emergency services have a $125 copay, and primary care visits have a $5-$15 copay, depending on the service. Preventive services, routine eye exams, and hearing exams have no copay, while dental services have a $2,500 annual maximum. This plan also includes coverage for ambulance services, with a $325 copay for ground and air ambulance. The plan offers additional benefits such as hearing aids up to $700 per year, vision services, and medical equipment with coinsurance. Other services, like home health and skilled nursing facilities, are also covered, but may require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $375 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $220 for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered, while 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 not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered by the Martin's Point Generations Advantage Alliance (HMO) plan. Outpatient hospital services have a copay between $0 and $275, observation services have a $275 copay, and ambulatory surgical center services have a $10 copay. Individual and group sessions for outpatient substance abuse, as well as outpatient blood services, are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Martin's Point Generations Advantage Alliance (HMO) plan. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Martin's Point Generations Advantage Alliance (HMO) plan. Ground and Air Ambulance Services have a $325 copay with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $325 copay; all services have no coinsurance. The plan also covers Worldwide Emergency Services up to a maximum of $25,000.
Primary Care See details
The Martin's Point Generations Advantage Alliance (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, opioid treatment program services, and additional telehealth benefits. Chiropractic services have a $5 copay, while routine chiropractic care has a $20 copay. Physician specialist services have a $15 copay. Additional telehealth benefits have a copay between $0 and $15.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services like health education (up to $50 per year), personal emergency response systems, and wigs for hair loss related to chemotherapy (lifetime maximum of $350). Some services, such as in-home safety assessments, therapeutic massage, adult day health services, post-discharge in-home medication reconciliation, re-admission prevention, enhanced disease management, telemonitoring services, in-home support services, support for caregivers of enrollees, are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $5 copay. Fitting/evaluation for hearing aids is covered, and prescription hearing aids are covered up to a $700 maximum benefit per year, per ear. 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 routine eye exams with no copay, and eyewear with a 20% coinsurance for contact lenses. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $2,500 annual maximum. Oral exams and dental x-rays are covered once per year, while Other Diagnostic Dental Services and Other Preventive Dental Services have a 20% coinsurance. Fluoride treatment, Implant Services, and Orthodontics are not covered. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery have a 50% coinsurance, and require prior authorization and a doctor referral.
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. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Martin's Point Generations Advantage Alliance (HMO) 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 a 10% coinsurance and no copay, Prosthetics/Medical Supplies with a 10% coinsurance and no copay, and Diabetic Equipment with no restrictions on manufacturers. 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 include coverage for all diagnostic services, with coinsurance and a copay for some services, and all radiological services, with coinsurance for diagnostic and therapeutic radiological services, as well as outpatient X-ray services. Diagnostic Procedures/Tests have a coinsurance of at most 5%, 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 5%.
Home Health Services See details
Home Health Services are covered by the Martin's Point Generations Advantage Alliance (HMO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Martin's Point Generations Advantage Alliance (HMO) plan, though 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 by the Martin's Point Generations Advantage Alliance (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Martin's Point Generations Advantage Alliance (HMO) plan covers acupuncture, over-the-counter (OTC) items with a maximum benefit of $100 every three months, meal benefits, and home infusion services, though several other "Other Services" are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services.
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