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Martin's Point Generations Advantage Prime (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Martin's Point Generations Advantage Prime (HMO-POS). 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 Prime (HMO-POS) in 2025, please refer to our full plan details page.
Martin's Point Generations Advantage Prime (HMO-POS) is a HMO-POS plan offered by Martin's Point Health Care, Inc. available for enrollment in 2025 to people living in Southern 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 Prime (HMO-POS) 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 Prime (HMO-POS).
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 Prime (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6750.00 (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 $6750.00 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 Prime (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible. In the initial coverage phase, you will pay a copay depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $10 copay at a preferred pharmacy or an $18 copay at a standard pharmacy. For specialty tier drugs, you will pay no copay at a preferred pharmacy or a $4 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Martin's Point Generations Advantage Prime (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital care, with varying copays depending on the service. This plan also covers a range of services like primary care, hearing, vision, and dental, with specific copays, coinsurance, and annual maximums for some services. Additional benefits include coverage for ambulance services, emergency services, and home health services with no copay, as well as coverage for medical equipment, diagnostic services, and skilled nursing facility stays. The plan also includes preventative services such as annual physical exams, and offers coverage for OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered. For Inpatient Hospital-Acute, you have a copay of $375 for days 1-7, and no copay for days 8-90. Inpatient Hospital Psychiatric has a copay of $220 for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $375, Observation Services with a $375 copay, Ambulatory Surgical Center (ASC) Services with a $250 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 by Martin's Point Generations Advantage Prime (HMO-POS) with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Martin's Point Generations Advantage Prime (HMO-POS). Ground and air ambulance services have a $325 copay, with 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Worldwide Emergency Transportation has a $325 copay, and Urgently Needed Services has a $55 copay; there is no coinsurance for any of these services.
Primary Care See details
The Martin's Point Generations Advantage Prime (HMO-POS) plan covers Primary Care Physician Services, 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 $25 copay for individual and group sessions, Other Health Care Professional services with a copay between $0 and $45, Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits with a copay between $0 and $45, and Opioid Treatment Program Services. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Martin's Point Generations Advantage Prime (HMO-POS) plan covers preventive services, including an annual physical exam, additional preventive services, medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. The plan does not cover health education, in-home safety assessments, personal emergency response systems, 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, or counseling services.
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 hearing aid purchase, and prescription hearing aids with a maximum plan benefit of $500 per ear every year; routine hearing exams, and prescription hearing aids for inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with a copay of $0-$45, and eyewear with 20% coinsurance for contact lenses. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered. The plan covers a maximum of $100 for combined eyewear benefits per year.
Dental Services See details
Dental services are covered, with a $1,250 annual maximum. The plan has a $50 copay for Medicare and other dental services, and for other diagnostic and preventive services, there is a $50 copay and 50% coinsurance. Oral exams and dental x-rays are covered. However, fluoride treatment, implant services, orthodontics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including 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. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan, but require prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices and Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment. 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 under the Martin's Point Generations Advantage Prime (HMO-POS) plan. 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%, while Outpatient X-Ray Services have a coinsurance of at most 15%.
Home Health Services See details
Home Health Services are covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. 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 Prime (HMO-POS) plan covers acupuncture with no copay and no coinsurance, and also covers over-the-counter (OTC) items up to $40 every three months. Home Infusion Services, which requires prior authorization and a doctor referral, is also covered. However, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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