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Martin's Point Generations Advantage Essential (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Martin's Point Generations Advantage Essential (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 Essential (HMO-POS) in 2026, please refer to our full plan details page.
Martin's Point Generations Advantage Essential (HMO-POS) is a HMO-POS plan offered by Martin's Point Health Care, Inc. available for enrollment in 2026 to people living in All Maine counties. 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 Essential (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 Essential (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 Essential (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 $300.00 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 $9000.00 (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 $9000.00 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 Essential (HMO-POS) prescription drug plan features an annual drug deductible of $300. Under this plan, Tier 1 preferred generic and Tier 2 generic medications have no copay when filled for any duration at a preferred pharmacy. If you use a standard pharmacy, copays for a one-month supply start at $4 for Tier 1 and $10 for Tier 2 drugs. For brand-name and specialty medications, your cost-sharing is based on coinsurance percentages. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance at preferred pharmacies and 32% at standard locations. Specialty drugs in Tier 5 require a 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Martin's Point Generations Advantage Essential (HMO-POS) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance. Members enjoy no copay for primary care physician visits, routine preventive services, and home health care, while specialist visits require a $55 copay. Emergency room visits carry a $115 copay, and urgent care services require a $40 copay, both with no coinsurance. For inpatient hospital stays, members pay a daily copay for the first five days and no copay thereafter, while skilled nursing facility stays require no copay for the first 20 days. Diagnostic lab work and home infusion services are covered with no copay, whereas durable medical equipment, prosthetics, and dialysis require a 20% coinsurance. The plan also partially covers dental, vision, and hearing services, alongside a $25 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Martin's Point Generations Advantage Essential (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute inpatient stays require a $489 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
Martin's Point Generations Advantage Essential (HMO-POS) covers outpatient hospital services with a $0 to $400 copay and ambulatory surgical center services with a $300 copay, both with no coinsurance. Outpatient substance abuse services require a $10 to $25 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Martin's Point Generations Advantage Essential (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under Martin's Point Generations Advantage Essential (HMO-POS) cover ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. While ambulance services are covered, transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Martin's Point Generations Advantage Essential (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $115 to $325, up to a $25,000 plan maximum.
Primary Care See details
Martin's Point Generations Advantage Essential (HMO-POS) provides primary care physician and opioid treatment services with no copay and no coinsurance, while specialist visits require a $55 copay and physical, occupational, and speech therapies require a $35 copay, both with no coinsurance. Additional benefits include mental health and psychiatric individual sessions for a $25 copay (group sessions are $10) and telehealth for a $0 to $55 copay, all with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Martin's Point Generations Advantage Essential (HMO-POS) with no copay and no coinsurance, including annual physical exams and kidney disease education. However, additional preventive services are only partially covered, excluding health education, weight management, alternative therapies, therapeutic massage, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Martin's Point Generations Advantage Essential (HMO-POS), featuring a $55 copay and no coinsurance for exams, though routine hearing exams and OTC hearing aids are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to $500 per ear annually, but inner ear, outer ear, and over-the-ear models are excluded.
Vision Services See details
Martin's Point Generations Advantage Essential (HMO-POS) partially covers vision services, offering one routine eye exam per year with a $0 to $55 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear has no deductible, no copay, and a 20% coinsurance for contact lenses up to a $100 annual maximum.
Dental Services See details
Martin's Point Generations Advantage Essential (HMO-POS) partially covers dental services, offering Medicare-covered dental with a $55 copay and no coinsurance, and select preventive and diagnostic dental services with a $50 copay and no coinsurance up to a $250 yearly maximum. Non-covered services include fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Martin's Point Generations Advantage Essential (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required and Part D home infusion drugs are not covered under the bundle. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Martin's Point Generations Advantage Essential (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by Martin's Point Generations Advantage Essential (HMO-POS), featuring no copay and a 20% coinsurance for durable medical equipment and prosthetics. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Martin's Point Generations Advantage Essential (HMO-POS) covers diagnostic services with no copay and no coinsurance for lab work, and a copay with no coinsurance for diagnostic tests. Radiological services require prior authorization and referrals, featuring a $25 copay plus coinsurance for X-rays, a 20% coinsurance and no copay for therapeutic radiology, and both a copay and 20% coinsurance for diagnostic radiology.
Home Health Services See details
Martin's Point Generations Advantage Essential (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Martin's Point Generations Advantage Essential (HMO-POS) indicates some services are covered under Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. However, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Martin's Point Generations Advantage Essential (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Martin's Point Generations Advantage Essential (HMO-POS) partially covers other services, offering Home Infusion Services and Over-the-Counter (OTC) items with no copay and no coinsurance. A maximum benefit of $25 every three months is available for OTC items, while acupuncture and meal benefits are not covered.
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