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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 $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 $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. During the initial coverage phase, you will pay a copay for your prescriptions, which varies depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies and $18 at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, if you qualify for the low-income subsidy, you'll pay $21.80. The plan's formulary provides more details on specific drug coverage.
Additional Benefits
The Martin's Point Generations Advantage Prime (HMO-POS) plan provides comprehensive coverage for a variety of services, including inpatient hospital stays, outpatient services, and emergency care, with varying copays depending on the service. It also offers benefits for primary care, hearing, vision, and dental services, along with coverage for home infusion, dialysis, and medical equipment. The plan includes additional benefits such as preventive services, ambulance services, and coverage for certain over-the-counter items. However, it's important to note that some services, like cardiac rehabilitation and certain home health services, are not covered, and prior authorization is required for specific treatments like partial hospitalization and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $220 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $280, observation services with a $375 copay, and ambulatory surgical center services with a $225 copay. Outpatient substance abuse services are covered with a $25 copay for both individual and group sessions, and outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Martin's Point Generations Advantage Prime (HMO-POS) plan, requiring prior authorization, with a copay of $70.
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 each have a $325 copay, with no coinsurance, and 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, Urgently Needed Services has a $55 copay, and Worldwide Emergency Transportation has a $325 copay. Worldwide Emergency Services has a maximum plan benefit coverage 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 $35 copay, mental health specialty 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 $0-$35 copay, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The Martin's Point Generations Advantage Prime (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, an annual physical exam, and additional preventive services, with some services like Health Education, In-Home Safety Assessment, and others not covered. The plan also covers Medical Nutrition Therapy, Wigs for Hair Loss Related to Chemotherapy (with a lifetime maximum benefit of $350), Weight Management Programs, Alternative Therapies, Fitness Benefits, Remote Access Technologies, Kidney Disease Education Services (with prior authorization required), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum plan benefit of $500 per ear every year. Routine hearing exams, prescription hearing aids (inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $35, and eyewear with 20% coinsurance. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services include a $50 copay for Medicare and other dental services, and a $50 copay and 50% coinsurance for Other Diagnostic Dental Services, Other Preventive Dental Services, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Prosthodontics (fixed), and Oral and Maxillofacial Surgery. Fluoride Treatment, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. There is a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Martin's Point Generations Advantage Prime (HMO-POS) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies, with a 20% coinsurance and no copay. 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%, 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 Martin's Point Generations Advantage Prime (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Martin's Point Generations Advantage Prime (HMO-POS) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Martin's Point Generations Advantage Prime (HMO-POS) with prior authorization required. 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 also covers over-the-counter (OTC) items with a maximum benefit of $50 every three months, including nicotine replacement therapy and Naloxone coverage. The plan does not cover 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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