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Martin’s Point Generations Advantage Access (PPO)

H1365 - 004 - 2
3 out of 5 stars (3 / 5)

Martin’s Point Generations Advantage Access (PPO) is a Medicare Advantage Plan by Martin’s Point Generations Advantage.

This page features plan details for 2025 Martin’s Point Generations Advantage Access (PPO) H1365 – 004 – 2 available in New Hampshire.

Locations

Martin’s Point Generations Advantage Access (PPO) is offered in the following locations.

Belknap County, New Hampshire
Carroll County, New Hampshire
Coos County, New Hampshire

Click to see more locations

Plan Overview

Martin’s Point Generations Advantage Access (PPO) offers the following coverage and cost-sharing.

Insurer:Martin’s Point Generations Advantage
Health Plan Deductible:$0
MOOP:$9,550 In and Out-of-network
$4,900 In-network
Drugs Covered:Yes

Ready to sign up for Martin’s Point Generations Advantage Access (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Martin’s Point Generations Advantage Access (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Martin’s Point Generations Advantage Access (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $200.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $200.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Martin’s Point Generations Advantage Access (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: Yes, contact plan for further details

Comprehensive Dental

  • Endodontics
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Implant Services
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Maxillofacial Prosthetics
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Maxillofacial Prosthetics
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Oral and Maxillofacial Surgery
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Periodontics
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Prosthodontics, fixed
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Prosthodontics, removable
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Restorative Services
    • In-Network: 50 Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)
    • Out-of-Network: 50% Coins – 50.00 Copay (Limits Apply, Authorization Required, Referral Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – – Copay
    • Out-of-Network: 50% Coins – 50.00 Copay
  • Oral Exams
    • In-Network: No Coins – – Copay
    • Out-of-Network: 50% Coins – 50.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – – Copay
    • Out-of-Network: 50% Coins – 50.00 Copay

Diagnostic procedures/lab services/imaging

  • Lab services
    • In-Network: $0-5 copay or 0-20% coinsurance (Authorization Required, Referral Required)
  • Outpatient x-rays
    • In-Network: 15% coinsurance (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 20-30% coinsurance (Authorization Required, Referral Required)
  • Diagnostic tests and procedures
    • In-Network: 0-15% coinsurance (Authorization Required, Referral Required)
    • Out-of-Network: 0-15% coinsurance (Authorization Required, Referral Required)
  • Outpatient x-rays
    • Out-of-Network: 15% coinsurance (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: 20% coinsurance (Authorization Required, Referral Required)
  • Lab services
    • Out-of-Network: $0-5 copay or 0-20% coinsurance (Authorization Required, Referral Required)

Doctor visits

  • Primary
    • In-Network: $0-5 copay per visit
    • In-Network: $0-10 copay per visit
    • Out-of-Network: $0-10 copay per visit
    • Out-of-Network: $0 copay
  • Specialist
    • Out-of-Network: $0-45 copay per visit (Referral Required)
    • In-Network: $45 copay per visit (Referral Required)
    • Out-of-Network: $10-45 copay per visit (Referral Required)

Emergency care/Urgent care

  • Urgent care
    • $55 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • In-Network: $10-45 copay (Referral Required)
    • Out-of-Network: 30% coinsurance (Referral Required)

Ground ambulance

    • In-Network: $325 copay
    • Out-of-Network: $325 copay

Health plan deductible

    • $0

Hearing

  • Medicare-Covered Hearing Exam
    • In-Network: $45 copay
    • In-Network: $45 copay (Referral Required)
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
    • In-Network: $0 copay (Limits Apply, Referral Required)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 30% coinsurance
    • Out-of-Network: 30% coinsurance (Referral Required)
  • Fitting/evaluation
    • Out-of-Network: $0 copay (Limits Apply, Referral Required)
  • Hearing aids
    • Out-of-Network: $0 copay (Limits Apply)

Inpatient hospital coverage

    • In-Network: $400 per day for days 1 through 7
      $0 per day for days 8 through 90 (Authorization Required)
    • In-Network: $395 per day for days 1 through 7
      $0 per day for days 8 through 90 (Authorization Required)
    • Out-of-Network: 40% per day for days 1 and beyond (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $9,550 In and Out-of-network
      $4,900 In-network
    • $9,550 In and Out-of-network
      $5,900 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 20% coinsurance per item
    • In-Network: $0 copay
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $220 per day for days 1 through 7
      $0 per day for days 8 through 90 (Authorization Required)
    • Out-of-Network: 30% per day for days 1 and beyond (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $25 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $25 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $25 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $25 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-395 copay per visit (Authorization Required)
    • Out-of-Network: 30% coinsurance per visit (Authorization Required)
    • In-Network: $0-350 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: 30% coinsurance

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: 30% coinsurance (Referral Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $30 copay (Referral Required)
    • Out-of-Network: 30% coinsurance (Referral Required)
  • Occupational therapy visit
    • In-Network: $30 copay (Referral Required)

Skilled Nursing Facility

    • Out-of-Network: 30% per day for days 1 through 100 (Authorization Required)
    • In-Network: $10 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 30% coinsurance (Limits Apply)
  • Upgrades
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Martin’s Point Generations Advantage Access (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Martin’s Point Generations Advantage Access (PPO)? See 2025 Martin’s Point Generations Advantage Access (PPO) at MedicareAdvantageRX.com.

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