A non-government entity
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 Northeastern ME. 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:
Sign up for Martin's Point Generations Advantage Prime (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Martin's Point Generations Advantage Prime (HMO-POS) plan features an annual drug deductible of $275. For Tier 1 (Preferred Generic) and Tier 6 (Select Care) drugs, members pay no copay at preferred pharmacies or through standard mail order. Tier 2 (Generic) drugs also have no copay at preferred pharmacies, while standard pharmacies charge low copays starting at $4. Higher-tier medications under this plan require coinsurance instead of copays. Tier 3 (Preferred Brand) drugs have a flat 25% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 30% to 32% coinsurance, and Tier 5 (Specialty) drugs require 29% coinsurance. Choosing preferred pharmacies for your prescriptions can help minimize your overall out-of-pocket costs.
Additional Benefits
The Martin's Point Generations Advantage Prime (HMO-POS) plan offers robust coverage with low out-of-pocket costs for essential medical care. Members enjoy no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. For specialized care, there is a $40 copay for specialist visits, a $115 copay for emergency room services, and a $350 daily copay for the first five days of inpatient hospital stays. The plan also includes valuable supplemental benefits such as dental, vision, and hearing coverage, featuring a $750 annual dental limit and up to $500 per ear yearly for prescription hearing aids. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance. Additionally, members receive an over-the-counter allowance of up to $50 every three months with no copay.
Inpatient Hospital See details
Martin's Point Generations Advantage Prime (HMO-POS) covers inpatient acute hospital stays with no coinsurance and a $350 daily copay for days 1 to 5, followed by no copay for days 6 to 90, with unlimited additional days. Inpatient psychiatric hospital stays are covered with no coinsurance and a $275 daily copay for days 1 to 5, then no copay for days 6 to 90, though additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers outpatient hospital services with a $0 to $300 copay and ambulatory surgical center services with a $250 copay, both with no coinsurance. Outpatient substance abuse services require a $10 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Martin's Point Generations Advantage Prime (HMO-POS) covers partial hospitalization services with a $75.00 copay and no coinsurance. Prior authorization is required for these covered 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. Routine transportation services to health-related locations are not covered under this plan.
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, with no coinsurance and no deductible. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 maximum benefit 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 and opioid treatment with no copay and no coinsurance. Specialist visits require a $40 copay, therapy services (physical, occupational, and speech) require a $30 copay, and mental health or psychiatric individual sessions require a $25 copay (group sessions are $10), all with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Martin's Point Generations Advantage Prime (HMO-POS) with no copay and no coinsurance for covered care like annual exams, kidney disease education, and fitness benefits. However, several sub-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 palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Martin's Point Generations Advantage Prime (HMO-POS) provides partially covered hearing services, featuring hearing exams for a $40 copay and no coinsurance, though routine exams are not covered and a referral is required. Prescription hearing aids are covered with no copay and no coinsurance up to $500 per ear yearly, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers routine eye exams once per year with a copay of $0 to $40 and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay and a 20% coinsurance for contact lenses, up to a combined annual maximum benefit of $150 for lenses, frames, upgrades, and contacts.
Dental Services See details
Martin's Point Generations Advantage Prime (HMO-POS) offers partially covered dental services up to a $750 annual limit, with Medicare-covered dental requiring a $40 copay and no coinsurance. Preventive services like cleanings and exams have no coinsurance, while comprehensive services generally 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. Associated Medicare Part B drugs, such as chemotherapy and radiation therapies, range from no coinsurance to 20% coinsurance, while covered Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
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 services.
Medical Equipment See details
Martin's Point Generations Advantage Prime (HMO-POS) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment is partially 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 under Martin's Point Generations Advantage Prime (HMO-POS), requiring prior authorization and referrals. Lab services feature no copay and no coinsurance, outpatient x-rays require a $25 copay and a minimum 15% coinsurance, and other covered diagnostic and therapeutic radiological services require a copay and/or a minimum 15% coinsurance.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Martin's Point Generations Advantage Prime (HMO-POS) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, although prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
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 for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard 100 days are not covered.
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 for over-the-counter items with no copay and no coinsurance. Meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved