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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 2026, 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 Maine: Andr, Cumb, Kenn, Saga, York. 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 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 $38.00. 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 $300.00 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 $7000.00 (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 $7000.00 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) prescription drug plan features an annual drug deductible of $300. You will enjoy no copay for Tier 1 preferred generics and Tier 6 select care drugs when filled through preferred pharmacies or standard mail order. Tier 2 generic medications are also highly affordable, with copays starting at $5 for a one-month supply at preferred pharmacies. For brand-name and specialty medications, costs are based on coinsurance percentages rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 30% to 32% coinsurance depending on the pharmacy. Specialty drugs in Tier 5 are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
The Martin's Point Generations Advantage Prime (HMO-POS) plan offers comprehensive coverage with no copay and no coinsurance for primary care, preventive services, and home health care. For specialist visits, members pay a $40 copay with no coinsurance, while emergency room services require a $115 copay. Inpatient hospital stays require a $350 daily copay for the first five days, after which there is no copay, with no coinsurance required. Supplemental benefits include routine dental cleanings with no copay under a $1,000 annual limit, while comprehensive dental services require a $50 copay and 50% coinsurance. Hearing exams require a $40 copay, whereas prescription hearing aids are covered with no copay up to $500 per ear annually. Additionally, durable medical equipment and dialysis services feature no copay with a 20% coinsurance, and members receive a $50 quarterly over-the-counter allowance.
Inpatient Hospital See details
Martin's Point Generations Advantage Prime (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 5 of acute stays and a $275 daily copay for days 1 to 5 of psychiatric stays, followed by no copay for subsequent days. Prior authorization is required, and the benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers outpatient services with no coinsurance, featuring copays of $0 to $300 for outpatient hospital services, $300 per stay for observation services, and $250 for ambulatory surgical center visits. Outpatient substance abuse services require a $10 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Martin's Point Generations Advantage Prime (HMO-POS) covers partial hospitalization services with a $75 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Martin's Point Generations Advantage Prime (HMO-POS), which requires a $325 copay and no coinsurance for Medicare-covered ground and air ambulance services, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers emergency services with a $115 copay and urgent care with a $30 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency services are also covered up to a $25,000 maximum with no coinsurance and copays ranging from $115 for medical care to $325 for emergency transportation.
Primary Care See details
Martin's Point Generations Advantage Prime (HMO-POS) provides primary care and opioid treatment services with no copay and no coinsurance, while specialist visits require a $40 copay with no coinsurance. Physical, occupational, and speech therapies carry a $30 copay, mental health and psychiatric sessions have a $10 to $25 copay, and telehealth ranges from a $0 to $40 copay, all with no coinsurance. Podiatry is not covered, and chiropractic benefits are only partially covered, excluding routine and other chiropractic services.
Preventive Services See details
Preventive Services are covered by Martin's Point Generations Advantage Prime (HMO-POS) with no copay and no coinsurance, including annual physical exams, diabetes self-management, and glaucoma screenings. This benefit is partially covered because several sub-services—including health education, in-home safety assessments, PERS, medical nutrition therapy, therapeutic massage, adult day health, home-based palliative care, and in-home support—are not covered.
Hearing Services See details
Hearing services are partially covered by Martin's Point Generations Advantage Prime (HMO-POS), with covered hearing exams requiring a $40 copay and no coinsurance, and prescription hearing aids offering no copay and no coinsurance up to $500 per ear annually. Routine hearing exams, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Martin's Point Generations Advantage Prime (HMO-POS) provides partially covered vision services, featuring one annual routine eye exam with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no deductible, no copay, and a 20% coinsurance for contact lenses, up to a $150 annual combined limit for lenses, frames, and contacts.
Dental Services See details
Martin's Point Generations Advantage Prime (HMO-POS) offers partially covered dental services with a $1,000 annual limit, excluding fluoride, adjunctive general, implant, and orthodontic services. Medicare-covered dental requires a $40 copay and no coinsurance, routine 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 Prime (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while other Medicare Part B chemotherapy, radiation, and standard drugs carry no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Martin's Point Generations Advantage Prime (HMO-POS) 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 Prime (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers diagnostic and radiological services, requiring referrals and prior authorization. Lab services have no copay or coinsurance, diagnostic tests require a copay with no coinsurance, outpatient X-rays require a $25 copay plus coinsurance, and other radiological services carry a minimum 15% coinsurance and applicable copays.
Home Health Services See details
Home Health Services are covered under the Martin's Point Generations Advantage Prime (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Martin's Point Generations Advantage Prime (HMO-POS) with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Martin's Point Generations Advantage Prime (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $150 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Martin's Point Generations Advantage Prime (HMO-POS) partially covers other services with no copay and no coinsurance, which includes unlimited acupuncture, home infusion services, and a $50 allowance every three months for over-the-counter items. Meal benefits are not covered under this plan.
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