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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 Northern ME & Northern NH. 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 $93.00. 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 $6750.00 (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 $6750.00 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 an enhanced alternative drug benefit. There is no 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 pharmacy. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Martin's Point Generations Advantage Prime (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and coverage for emergency services. The plan also covers a variety of services like primary care, preventive care, hearing, vision, and dental services, often with copays or coinsurance. This plan includes additional benefits such as ambulance services, home health, and skilled nursing facility stays, but it's important to note that prior authorization may be required for some services. Other services such as home infusion, dialysis, and medical equipment are also covered, as are other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, there is a $375 copay for days 1-7 and no copay for days 8-90; for Inpatient Hospital Psychiatric, there is a $220 copay for days 1-7 and no copay for days 8-90.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $325, observation services with a $375 copay, and ambulatory surgical center (ASC) services with a $225 copay. Outpatient substance abuse services are covered with a $25 copay for individual sessions and a $10 copay for group sessions, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $325 copay, and there is no coinsurance. 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, Worldwide Emergency Transportation has a $325 copay, and Urgently Needed Services has a $55 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 $45 copay, and mental health specialty services with a $25 copay for individual sessions and a $10 copay for group sessions. The plan does not cover podiatry services, and covers other health care professionals with a copay between $0 and $45, psychiatric services with a $25 copay for individual sessions and a $10 copay for group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services, with some services such as Health Education, In-Home Safety Assessment, and Therapeutic Massage not covered. The plan also covers Medical Nutrition Therapy (MNT) with a limit of 2 additional hours, wigs for hair loss related to chemotherapy up to $350, weight management programs, alternative therapies, fitness benefits, and remote access technologies.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, fitting/evaluation for hearing aids, and prescription hearing aids. 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 of $0-$45 and eyewear, which includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited.
Dental Services See details
Dental services are covered, including Medicare dental services, other dental services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery. The plan has a $50 copay for many services, a 50% coinsurance for other diagnostic dental services, other preventive dental services, and most restorative services, and does not cover fluoride treatment, adjunctive general services, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Martin's Point Generations Advantage Prime (HMO-POS) with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with some services not covered. 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 or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Martin's Point Generations Advantage Prime (HMO-POS). Specifically, 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 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 it covers over-the-counter items with a $50 maximum benefit every three months. Other services, including meal benefits, are not covered.
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