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Martin's Point Generations Advantage Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Martin's Point Generations Advantage Value Plus (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 Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Martin's Point Generations Advantage Value Plus (HMO-POS) is a HMO-POS plan offered by Martin's Point Health Care, Inc. available for enrollment in 2025 to people living in Northern, Central, Midcoast, and Southern Maine. 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 Value Plus (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 Value Plus (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 Value Plus (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 a $150.00 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 $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 Value Plus (HMO-POS) plan has a $150 deductible for prescription drugs. Once you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $42 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), you may have your premium reduced.
Additional Benefits
The Martin's Point Generations Advantage Value Plus (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Primary care, including specialist visits, mental health, and physical therapy, is covered with copays ranging from $15 to $45. The plan also includes coverage for emergency services, ambulance services, and a range of preventive services. Hearing, vision, and dental services are also included, with hearing aids covered up to $500 per ear annually and vision exams with no copay. Dental services have a $50 copay and 50% coinsurance for many services. The plan also includes home infusion, dialysis, medical equipment, diagnostic services, and home health services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a copay of $375 for days 1-7 and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a copay of $365 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $320, 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 with a $70 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $325 copay for both Ground and Air Ambulance Services, and no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Martin's Point Generations Advantage Value Plus (HMO-POS). Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $55 copay, and Worldwide Emergency Transportation has a $325 copay. Worldwide Urgent Coverage also has a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
The Martin's Point Generations Advantage Value Plus (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, while occupational therapy has a $30 copay and requires a referral. Physician specialist services have a $45 copay, and mental health, psychiatric, and physical therapy services have a $25-$30 copay, with individual and group sessions covered. Additional telehealth benefits have a $0-$45 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered. Additional preventive services include Medical Nutrition Therapy with a limit of 2 hours, Wigs for Hair Loss Related to Chemotherapy with a lifetime maximum benefit of $350, Weight Management Programs, Alternative Therapies, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System, 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, and Counseling Services.
Hearing Services See details
Hearing Services includes hearing exams with a $45 copay, fitting/evaluation for hearing aids, and prescription hearing aids (all types) 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 eye exams and eyewear. Eye exams have a copay of $0-$45, and eyewear has a 20% coinsurance for contact lenses.
Dental Services See details
Dental Services are covered by the Martin's Point Generations Advantage Value Plus (HMO-POS) plan. Medicare and other dental services have a $50 copay, while other diagnostic dental services, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery have a 50% coinsurance and a $50 copay. However, fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and other Medicare Part B drugs. For Medicare Part B Insulin Drugs, the copay is $35.00. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Martin's Point Generations Advantage Value Plus (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment, however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic procedures/tests have a coinsurance of at most 15%, lab services have no copay and a coinsurance of at most 20%, and radiological services have a coinsurance of at most 20%, with outpatient x-ray services having a $15 copay.
Home Health Services See details
Home Health Services are covered by the Martin's Point Generations Advantage Value Plus (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Martin's Point Generations Advantage Value Plus (HMO-POS) plan. 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 Martin's Point Generations Advantage Value Plus (HMO-POS) with prior authorization required. The copay is $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture is covered with no copay or coinsurance. OTC items are covered up to $60 every three months.
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