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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 2026 to people living in Lincoln, Oxford, Pisataquis, Somerset, Waldo. 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 $109.00. 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 $275.00 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 an annual drug deductible of $275. Under this plan, you will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filling your prescription at a preferred pharmacy. If you choose a standard pharmacy, copays for these lower-tier medications remain highly affordable, starting at just $4 for a one-month supply. For brand-name and specialty prescriptions, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs range from 30% to 32% coinsurance depending on your pharmacy choice. Tier 5 specialty tier drugs carry a 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
Martin's Point Generations Advantage Prime (HMO-POS) offers robust medical coverage with affordable out-of-pocket costs, featuring no copay for primary care visits and a $40 copay for specialists. For inpatient hospital stays, members pay a $350 daily copay for days one through five, with no copay for day six and beyond. Emergency room visits require a $115 copay, which is waived if admitted within 24 hours, while urgently needed services have a $30 copay. In addition to core medical services, the plan provides valuable extra benefits including routine dental cleanings and preventive services with no copay. Comprehensive dental care is covered up to a $750 annual maximum with a $50 copay and 50% coinsurance, and members receive a $150 annual eyewear allowance and a $50 quarterly over-the-counter item benefit with no copay. Hearing exams are available for a $40 copay, with up to $500 per ear covered annually for prescription hearing aids.
Inpatient Hospital See details
Martin's Point Generations Advantage Prime (HMO-POS) covers inpatient acute hospital stays with no coinsurance, a $350 daily copay for days 1 through 5, and no copay for days 6 and beyond. Inpatient psychiatric stays are covered with no coinsurance, a $275 daily copay for days 1 through 5, and no copay for days 6 through 90, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $300 copay and observation services at a $300 copay per stay. Ambulatory surgical center services require a $250 copay and no coinsurance, while outpatient substance abuse sessions carry a $10 to $25 copay and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Martin's Point Generations Advantage Prime (HMO-POS) with a $75 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers Medicare-approved ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. Transportation services, including rides to plan-approved or any other 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 with no coinsurance and waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are also covered up to a $25,000 lifetime 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) offers primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits require a $40 copay and physical therapy costs $30, both with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered, and podiatry services are not covered by the plan.
Preventive Services See details
Preventive Services are covered under Martin's Point Generations Advantage Prime (HMO-POS) with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive benefits are partially covered; fitness, weight management, and alternative therapies are included, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Martin's Point Generations Advantage Prime (HMO-POS), which offers hearing exams with a $40 copay and no coinsurance, though routine hearing exams are not covered. Prescription hearing aids are also partially covered with no copay and no coinsurance up to $500 per ear annually, but OTC, 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, though other eye exam services are not covered. Routine eye exams are covered with a $0 to $40 copay and no coinsurance, while eyewear is covered up to $150 annually with no copay and a 20% coinsurance for contact lenses.
Dental Services See details
Dental services are partially covered under Martin's Point Generations Advantage Prime (HMO-POS), as fluoride, implants, orthodontics, and adjunctive general services are not covered. Preventive services like cleanings and exams feature no copay and no coinsurance, while Medicare-covered dental has a $40 copay and no coinsurance, and comprehensive services require a $50 copay and 50% coinsurance up to a $750 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Martin's Point Generations Advantage Prime (HMO-POS) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Martin's Point Generations Advantage Prime (HMO-POS) covers medical equipment with no copay, though durable medical equipment and prosthetics require prior authorization and 20% coinsurance. Some diabetic equipment services are covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Martin's Point Generations Advantage Prime (HMO-POS), featuring no copay or coinsurance for lab services and a $25 copay with a minimum 15% coinsurance for outpatient X-rays. Other diagnostic procedures require a copay with no coinsurance, while radiological services are subject to a minimum 15% coinsurance and applicable copayments.
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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Martin's Point Generations Advantage Prime (HMO-POS) feature no copay and no coinsurance, subject to prior authorization. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Martin's Point Generations Advantage Prime (HMO-POS) with no coinsurance, as additional days beyond Medicare-covered services are not covered. This benefit requires prior authorization, offering no copay for days 1 to 20 and a $150 copay for days 21 to 100, without requiring a prior three-day inpatient hospital stay.
Other Services See details
Martin's Point Generations Advantage Prime (HMO-POS) partially covers other services, offering acupuncture, home infusion services, and up to $50 every three months in over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits are not covered under this benefit.
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