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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 2026, 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 Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
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 offers robust medical coverage with no copay or coinsurance for primary care visits, preventive services, and urgent care. Specialists require a low $15 copay, while inpatient hospital stays cost a $350 daily copay for the first five days and no copay for additional days. Emergency room visits carry a $125 copay, which is waived if you are admitted within 24 hours. For dental, vision, and hearing needs, members benefit from no copay on routine exams and cleanings, alongside a $2,500 annual dental maximum and a $700 yearly allowance per ear for prescription hearing aids. Vision coverage includes a routine eye exam with no copay and a $200 annual allowance for eyewear with 20% coinsurance. Other essential services like home health care and partial hospitalization are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Martin's Point Generations Advantage Alliance (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for unlimited additional days. Inpatient psychiatric stays are also covered with no coinsurance, featuring a $220 daily copay for days 1 through 7 and no copay for days 8 through 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Martin's Point Generations Advantage Alliance (HMO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $275, alongside ambulatory surgical center services for a $10 copay and no coinsurance. Outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse services cover some services but do not cover individual or group sessions.
Partial Hospitalization See details
Partial hospitalization is covered under the Martin's Point Generations Advantage Alliance (HMO) with no copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Martin's Point Generations Advantage Alliance (HMO) covers Medicare-approved ground and air ambulance services with a $325 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Martin's Point Generations Advantage Alliance (HMO) covers emergency services with a $125 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum benefit with no coinsurance and copays of $125 for emergency or urgent care and $325 for emergency transportation.
Primary Care See details
Martin's Point Generations Advantage Alliance (HMO) offers primary care, occupational and physical therapy, and opioid treatment with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Chiropractic services are partially covered, featuring a $20 copay and no coinsurance for routine care, though other chiropractic services and podiatry are not covered. For mental health specialty and psychiatric services, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive Services are partially covered by Martin's Point Generations Advantage Alliance (HMO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. However, several sub-services are not covered, including health education, in-home safety assessments, therapeutic massage, medical nutrition therapy, in-home support, caregiver support, and telemonitoring.
Hearing Services See details
Hearing services are partially covered by Martin's Point Generations Advantage Alliance (HMO), which offers hearing exams for a $5.00 copay and no coinsurance, though routine hearing exams and OTC hearing aids are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to $700 per ear every year, but inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Martin's Point Generations Advantage Alliance (HMO) offers partially covered vision services, including one routine eye exam annually with no copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no deductible, and a 20% coinsurance for contact lenses, up to a $200 combined annual limit for contacts, lenses, frames, and upgrades.
Dental Services See details
Martin's Point Generations Advantage Alliance (HMO) offers partially covered dental services up to a $2,500 annual maximum, featuring no copay and no coinsurance for routine exams and cleanings, and no copay with 20% to 50% coinsurance for comprehensive services. Fluoride treatment, adjunctive general services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Martin's Point Generations Advantage Alliance (HMO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a 0% to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Martin's Point Generations Advantage Alliance (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Martin's Point Generations Advantage Alliance (HMO) partially covers medical equipment, excluding diabetic supplies and therapeutic shoes or inserts. Covered durable medical equipment, prosthetics, and medical supplies require prior authorization and have no copay and a 10% coinsurance, while diabetic equipment features no copay and no coinsurance.
Diagnostic and Radiological Services See details
Martin's Point Generations Advantage Alliance (HMO) covers diagnostic and radiological services with prior authorization and referrals required. Lab services have no copay or coinsurance, diagnostic tests require a copay with no coinsurance, and radiological services, including X-rays with a $15 copay, carry a 20% coinsurance and applicable copays.
Home Health Services See details
Martin's Point Generations Advantage Alliance (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Martin's Point Generations Advantage Alliance (HMO), as the plan excludes coverage for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Martin's Point Generations Advantage Alliance (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Martin's Point Generations Advantage Alliance (HMO) with no copay and no coinsurance for acupuncture, over-the-counter (OTC) items, home infusion, and meals, while dual eligible SNP services are not covered. This benefit includes unlimited acupuncture, a $100 quarterly OTC allowance, and homebound meal delivery, though some services require prior authorization and referrals.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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