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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 $49.00. 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) plan features a $300 annual drug deductible. You will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs when filled at a preferred pharmacy or through standard mail order. For Tier 2 generics, copays range from $5 at preferred pharmacies to $10 at standard pharmacies for a one-month supply. For higher-tier medications, Tier 3 preferred brands require a 25% coinsurance at both preferred and standard pharmacies. Tier 4 non-preferred drugs carry a 30% coinsurance at preferred pharmacies and 32% coinsurance at standard pharmacies or standard mail order. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply across all available pharmacy options.
Additional Benefits
The Martin's Point Generations Advantage Prime (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and home health services. Specialist visits require a $40 copay, while inpatient hospital stays incur a $350 daily copay for the first five days with no copay thereafter. Emergency care is covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For supplemental care, the plan provides routine dental cleanings and exams with no copay or coinsurance up to a $1,000 annual maximum, along with yearly routine eye exams ranging from no copay to a $40 copay. Prescription hearing aids are covered up to $500 per ear annually with no copay, while durable medical equipment requires a 20% coinsurance with no copay. Skilled nursing facility stays are also covered with no copay for the first 20 days and a $150 daily copay for days 21 through 100.
Inpatient Hospital See details
Martin's Point Generations Advantage Prime (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay thereafter, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is also covered with no coinsurance, requiring a $275 daily copay for days 1 to 5 and no copay for days 6 to 90, while additional psychiatric days are excluded.
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 hospital services, $300 per stay for observation, and $250 for ambulatory surgical center visits. Outpatient substance abuse sessions require a $10 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Martin's Point Generations Advantage Prime (HMO-POS) covers partial hospitalization with a $75.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Martin's Point Generations Advantage Prime (HMO-POS) with a $325 copay and no coinsurance for ground and air ambulance services, which require prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $30 copay, both featuring no coinsurance and copay waivers if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are also covered up to a $25,000 maximum with no coinsurance, requiring a $115 copay for emergency or urgent care and a $325 copay for emergency transportation.
Primary Care See details
Martin's Point Generations Advantage Prime (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, speech, and occupational therapies require a $30 copay and no coinsurance, while chiropractic services are partially covered with routine and other chiropractic services not covered, and podiatry services are not covered.
Preventive Services See details
Martin's Point Generations Advantage Prime (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, kidney education, and glaucoma screenings. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Hearing services are covered by Martin's Point Generations Advantage Prime (HMO-POS) with a $40 copay and no coinsurance for exams, although routine exams and OTC hearing aids are not covered. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear annually, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Martin's Point Generations Advantage Prime (HMO-POS) provides partially covered vision services, with other eye exam services not covered. Routine eye exams are covered once yearly with a $0 to $40 copay and no coinsurance, and eyewear has no copay and a 20% coinsurance for contact lenses up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by Martin's Point Generations Advantage Prime (HMO-POS), featuring a $1,000 annual maximum and no copay or coinsurance for routine cleanings, exams, and x-rays. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered comprehensive services require a $50 copay and 50% coinsurance. Fluoride treatments, adjunctive general services, implant services, and orthodontics are not covered.
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 chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Martin's Point Generations Advantage Prime (HMO-POS) plan 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 a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and 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 and no coinsurance, outpatient x-rays require a $25 copay and 15% coinsurance, and diagnostic tests require a copay with no coinsurance. Diagnostic radiological services require a copay and 15% coinsurance, while therapeutic radiological services require 15% coinsurance with no copay.
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 not covered under the Martin's Point Generations Advantage Prime (HMO-POS) plan, as none of the specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered.
Skilled Nursing Facility (SNF) See details
Martin's Point Generations Advantage Prime (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $150 copay per day for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the Medicare-covered 100 days 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, including acupuncture, home infusion services, and over-the-counter items with a $50 maximum benefit every three months. Meal benefits are not covered under this plan.
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