- Martin’s Point is a Medicare Advantage (Part C) plan provider.
- Martin’s Point offers a variety of plans to residents in Maine and New Hampshire.
Martin’s Point Generations Advantage is a Medicare Part C plan that offers a variety of Medicare services in packages tailored for your needs and budget. Like all Medicare Advantage plans, Martin’s Point plans are optional.
Martin’s Point Health Care is a not-for-profit healthcare company that provides both direct patient care, as well as healthcare plans. The organization has several Medicare Advantage plans available to people who are eligible for Medicare and live within their service area.
Read on to discover information about the Martin’s Point Health Care’s Medicare plans.
Martin’s Point offers statewide coverage for residents of Maine and New Hampshire, but Medicare Part C availability depends on which county you live in.
Like most Medicare Advantage plans, specific options for coverage under Martin’s Point Generations Advantage plans varies by location.
Martin’s Point Health Care offers the following types of Medicare Advantage plans:
- Preferred Provider Organization (PPO) plans. PPO plans allow you to use reduced cost medical services from a network of approved providers and to seek care from out-of-network providers at an increased cost. Martin’s point offers both regional PPO (RPPO) and local PPO (LPPO) options.
- Health Maintenance Organization (HMO) plans. HMO plans provide healthcare via facilities and networks of approved network healthcare providers. Medicare services provided outside this network are generally not covered except when specified.
- Special Needs Plans (SNP). SNPs are healthcare plans (HMO or PPO) designed specifically for individuals with certain medical conditions. These plans were created to help people with chronic health conditions access services and coordinate their care.
Martin’s Point Health Care offers six different Medicare Advantage plans under its Martin’s Point Generations Advantage program. If you live in Maine or New Hampshire, you can find Martin Point Health Care plans available in your area by using Medicare’s plan finder tool.
Martin’s Point Generations Advantage Plans include:
Generations Advantage Prime (HMO-POS)
This plan is an HMO Point-of-Service (HMO-POS) plan that offers medical, hospital, and prescription coverage. In-network care is included with low copayments, but the POS program also allows you to use out-of-network providers for certain services. It’s available throughout Maine and New Hampshire.
Generations Advantage Flex (RPPO)
This plan covers physician and hospital services as well as prescription medications. It was created to offer increased flexibility, allowing out-of-network coverage at an additional cost. It is available throughout Maine and New Hampshire.
Generations Advantage Select (LPPO)
This is another plan focused on flexibility with increased coverage for out-of-network services. The plan covers physician and hospital services, as well as prescription medications. Unlike the Flex plan, this plan does not include dental coverage. It is available throughout Maine and New Hampshire.
Generations Advantage Value (HMO)
This HMO plan covers physician and hospital services with supplemental coverage but does not contain a prescription plan. You are required under this plan to use in-network providers for all services except urgent and emergency care. It is available throughout Maine and New Hampshire.
Generations Advantage Value Plus (HMO)
This HMO plan covers physician and hospital services plus prescription drugs. You are required under this plan to use in-network providers for all services except urgent and emergency care. It is available throughout Maine except for in Cumberland county, and only in Hillsborough and Strafford counties in New Hampshire.
Generations Advantage Focus DC (HMO SNP)
This HMO SNP covers physician and hospital services plus prescriptions for Cumberland County residents in Maine who have been diagnosed with diabetes. You are required under this plan to use in-network providers for all services except urgent and emergency care.
Depending on the plan you choose, Medicare Advantage plans like Martin’s Choice will cost you a monthly premium, plus deductibles, coinsurances, and copayments.
For most Martin’s Point plans, premiums are free or under $100 per month. Most plans have no deductibles except for prescriptions — and they limit copayments to specialty services or out-of-network providers.
Martin’s Point plans are available to residents in Maine and New Hampshire, with services limited in some counties. Here are examples of what the Martin’s Point plans will cost in various cities.
The following table compares benefits and costs of the six Martin’s Point Generations Advantage plans.
Martins Point plans benefits and costs comparison:
| Generations Advantage Prime (HMO-POS) | Generations Advantage Flex (RPPO) | Generations Advantage Select (LPPO) | Generations Advantage Value (HMO) | Generations Advantage Value Plus (HMO) | Generations Advantage Focus DC (HMO SNP) | |
|---|---|---|---|---|---|---|
| Available in ME and NH | Yes | Yes | Yes | Yes | Limited counties | Cumberland County, ME only |
| Premiums | Based on your county | Based on your county | Based on your county | Based on your county / $55 Part B reduction | based on your county / $55 Part B reduction | No premium besides Part B |
| Deductible for hospital or doctor visits | No | No | No | No | No | No |
| Copay primary care | $0 in network, $35 out of network |
$0 in network, $30 out of network |
$0 in network, 30% out of network |
$0 in network only | $10 in network only | $0 in network only |
| Copay specialists | $40 in network, $55 out of network | $40 in network, 30% out of network | $40 in network, 30% out of network | $5 in network, no coverage out of network |
$50 in network, no coverage out of network |
$40 (in-network coverage others), $0 a few specific in-network specialists (see policy) |
| Part D deductible | No | $275 for tiers 3 to 5 medications | No | N/A | $275 for tiers 3 to 5 medications | No |
| Annual out-of-pocket maximum (not including premiums and Rx copays) |
$6,500 in network and out of network | $5,500 in network, $8,000 for combined in and out of network |
$6,700 in network, $10,000 for combined in and out of network | $5,000 in network only | $6,700 in network only | $5,500 in network only |
| Prescrip-tion medica-tion coverage and more |
$0 copay for generic prescriptions filled at preferred cost sharing program pharmacy/ $50 per quarter toward CVS-brand OTC items |
$2 copay for generic prescriptions filled at Hannaford Pharmacy/ $0 for generic medications ordered through the mail-order pharmacy program/ $50 per quarter toward CVS-brand OTC items |
$0 copay for generic prescriptions filled at Hannaford Pharmacy/ $50 per quarter toward CVS-brand OTC items |
No Part D plan/ prescription coverage only through an employer or VA program/ $180 per quarter toward CVS-brand OTC items |
$50 per quarter toward CVS-brand OTC items | $50 per quarter toward CVS-brand OTC items |
| Free physical (in network) |
Yes | Yes (30% of out of network cost) |
Yes (30% of out of network cost) |
Yes | Yes | Yes |
| Vision | $0 in network routine vision exams/ (30% of out of network cost)/ some reimbursement for glasses or contacts |
$0 in network routine vision exams/ (30% of out of network cost)/ some reimbursement for glasses or contacts |
$0 in network routine vision exams/ (30% of out of network cost)/ some reimbursement for glasses or contacts |
$0 in-network routine vision exams, $400 per year for glasses, frames, or contacts | $0 in-network routine vision exams | $0 in-network routine vision exams |
| Hearing aid coverage | $595–$895 per year based on the tier | $595–$895 per year based on the tier | $595–$895 per year based on the tier | $0–$295 per year based on the tier | $595–$895 per year based on the tier | No |
| Dental | $50 copay/ $1,000 benefit maximum/ full coverage of diagnostic and preventive dental services, coverage of restoratives services with one-time $50 deductible & 50% coinsurance |
$50 copay/ $1,000 benefit maximum/ full coverage of diagnostic and preventive dental services, coverage of restoratives services with one-time $50 deductible & 50% coinsurance |
No | $5 copay/ $2,000 benefit maximum/ full coverage of diagnostic and preventive dental services, coverage of in-network restoratives services with 20%-50% coinsurance |
No | No |
| Free preventive care visits | Yes | Yes (in network) |
Yes (in network) |
Yes (in network) |
Yes (in network) |
Yes (in network) |
| Free annual flu shots | Yes | Yes (in network & select pharmacies) |
Yes (in network & select pharmacies) |
Yes (in network & select pharmacies) |
Yes (in network & select pharmacies) |
Yes (in network & select pharmacies) |
| Nation-wide urgent care | Yes | Yes | Yes | Yes | Yes | Yes |
| Worldwide emer-gency care | Yes | Yes | Yes | Yes | Yes | Yes |
| Other health services | $400 in reimbursement for some wellness products and services | $200 in reimbursement for some wellness products and services | $200 in reimbursement for some wellness products and services | $350 in reimbursement for some wellness products and services/ free outpatient therapy (in network)/ $20 chiropractic visits/ free personal emergency response system |
$300 in reimbursement for some wellness products and services | $450 in reimbursement for some wellness products and services |
Five of the Martin’s Point Generations Advantage plans offer prescription drug coverage. These are:
- Prime (HMO-POS)
- Flex (RPPO)
- Select (LPPO)
- Value Plus (HMO)
- Focus DC (HMO SNP)
Prescription plans in the program offer prescriptions with no deductible, or a $275 deductible for medications in tiers 3 to 5 of the formulary. There are different limits for copayments on generic and brand name medications at certain pharmacies or thorough a mail-order program.
Martin’s Point offers several different Medicare Advantage plans, but each plan features a core set of services.
Every Martin’s Point Generations Advantage plan includes the following coverage.
- physician and hospital visits
- free in-network preventive screenings and care
- no deductibles for medical and hospital services
- free in-network annual wellness visits and physical exams
- caps on annual out-of-pocket costs
- nationwide access to urgent care services
- worldwide emergency care
- coverage for routine vision exams
- coverage for hearing aids and batteries
- coverage for certain over-the-counter healthcare products
- reimbursement for “Wellness Wallet” items including glasses and contact lenses, naturopathic treatments, nutrition products and services, and fitness services and equipment
Medicare Part C, or Medicare Advantage, plans combine multiple Medicare elements into a single package. Typically, Medicare beneficiaries have a Medicare Part A plan for inpatient needs and a Medicare Part B plan for outpatient needs. Prescription and supplemental plans are optional.
While Medicare parts A and B can be provided directly by Medicare, Medicare Part D’s prescription plans are offered through private plans. Medicare Advantage is a hybrid Medicare product offered by private plans. It combines Medicare parts A and B, plus other elements like prescription coverage, dental, vision, and more.
Medicare Part D is Medicare’s prescription medication plan. Administered by private insurance companies, this optional Medicare program charges a monthly premium in return for savings on prescription medications.
Plans use a formulary — or list of medications the plan covers — that usually include at least two medications for each drug category. For example, there would be two medication choices for your high blood pressure or your diabetes. Formularies include both generic and brand name medications.
If your prescription is not on the formulary, you could ask for an exception, or see if you can try and alternative medication. Formulary lists are updated by Medicare plans every year, and you will save the most money on your prescription medications by using drugs from your plan’s formulary.
- Martin’s Point is a not-for-profit healthcare organization that offers direct patient care and Medicare Advantage health plans in New Hampshire and Maine.
- Services and costs vary by county.
- You can choose a plan based on your needs and your budget.
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