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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 Maine: Andr, Cumb, Kenn, Saga, York. 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 $0.00. 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 $6350.00 (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 $6350.00 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 a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and the pharmacy you use. For example, you'll pay $10.00 for preferred generic drugs at a preferred pharmacy, and $4.00 for specialty tier drugs at a standard pharmacy. Once your total drug costs reach $2000.00, 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 a range of benefits with varying costs. Inpatient hospital stays have copays depending on the type of care and length of stay, while outpatient services have copays ranging from $0 to $325. Emergency services have a $125 copay. This plan covers primary care, hearing, vision, and dental services. Primary care visits have copays between $15 and $45, while vision services include eye exams with no copay and eyewear with 20% coinsurance. Dental services have a $750 maximum annual benefit, with copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care. For acute care, you'll pay a $375 copay for days 1-7, and no copay for days 8-90; for psychiatric care, you'll pay a $220 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $325, observation services with a $375 copay, ambulatory surgical center services with a $225 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan, with a $70 copay. Prior authorization is required for this benefit.
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, and there is no coinsurance, but Transportation Services 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 have no coinsurance. The plan also offers Worldwide Emergency Services with a maximum benefit of $25,000.
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, and Mental Health Specialty Services with a $25 copay for individual and group sessions. The plan also covers Other Health Care Professional services with a copay between $0 and $45, Psychiatric Services with a $25 copay for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Additionally, the plan offers 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
Preventive Services, including Medicare-covered services, annual physical exams, and additional services, are covered. Some services are not covered, including 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 and bathroom safety devices and modifications, counseling services, and enhanced disease management. Other covered services include medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing services include a $45 copay for hearing exams, and a fitting/evaluation for hearing aids benefit with unlimited visits within the first year of purchase. Prescription hearing aids are covered, with a maximum plan benefit of $500 per year, but some services like routine hearing exams, and certain types of hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$45, and eyewear with 20% coinsurance. Eyewear coverage includes contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, with a $750 maximum benefit per year. Medicare Dental Services and Other Dental Services have a $50 copay. Other Diagnostic Dental Services, Other Preventive Dental Services, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery have a $50 copay and 50% coinsurance. Fluoride Treatment, Adjunctive General Services, Implant Services, and Orthodontics are not covered. Oral Exams and Dental X-Rays are covered, but limited to 1 visit or X-ray per year.
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 Martin's Point Generations Advantage Prime (HMO-POS), with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, is covered under this plan. DME has a 20% coinsurance and no copay, and durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance and no copay. Diabetic equipment is covered, but diabetic supplies and therapeutic shoes/inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan. Diagnostic Procedures/Tests have a coinsurance of at most 15%, while 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 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 Martin's Point Generations Advantage Prime (HMO-POS), including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Martin's Point Generations Advantage Prime (HMO-POS) plan. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture, with no copay, and over-the-counter items, with a $50 allowance every three months, including nicotine replacement therapy and naloxone coverage. Home Infusion Services are covered, with a doctor referral and prior authorization required. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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