Martin’s Point Generations Advantage Flex (Regional PPO)
R0802 - 001 - 0
(4 / 5)
Martin’s Point Generations Advantage Flex (Regional PPO) is a Medicare Advantage Plan by Martin’s Point Generations Advantage.
This page features plan details for 2022 Martin’s Point Generations Advantage Flex (Regional PPO) R0802 – 001 – 0 available in Northern New England (New Hampshire and Maine).
IMPORTANT: This page features the 2022 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
Martin’s Point Generations Advantage Flex (Regional PPO) is offered in the following locations.
Plan Overview
Martin’s Point Generations Advantage Flex (Regional PPO) offers the following coverage and cost-sharing.
| Insurer: | Martin’s Point Generations Advantage |
| Health Plan Deductible: | $0 |
| MOOP: | $7,000.00 |
| Drugs Covered: | Yes |
Please Note:
- This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.
Ready to sign up for Martin’s Point Generations Advantage Flex (Regional 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 Flex (Regional PPO) has a monthly premium of $17.90. 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 |
|---|---|---|---|---|
| $170.10 | $35.10 | $17.90 | $0.00 | $ |
- 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 Flex (Regional PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $275.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | No |
| Formulary Link: | Formulary Link |
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 D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $17.90 | $13.40 | $8.90 | $4.50 | $0.00 |
Initial Coverage Phase
After you pay your $275.00 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 $4,430.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
30 Day
90 Day
30 Day
90 Day
| Drug Type | Cost Share |
|---|---|
| Generic drugs | 25% |
| Brand-name drugs | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $3.95 copay or 5% (whichever costs more) |
| Brand-name drugs | $9.85 copay or 5% (whichever costs more) |
Additional Benefits
Martin’s Point Generations Advantage Flex (Regional 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 |
Dental (comprehensive)
| Diagnostic services: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Diagnostic services: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
| Endodontics: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Endodontics: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
| Extractions: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Extractions: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
| Non-routine services: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Non-routine services: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
| Periodontics: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Periodontics: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
| Restorative services: | In-Network: $50 copay or 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Restorative services: | Out-of-Network: $50 copay or 50-75% coinsurance (limits may apply) (authorization required) (referral required) |
Dental (preventive)
| Cleaning: | Covered under office visit (limits may apply) |
| Dental x-ray(s): | Covered under office visit (limits may apply) |
| Fluoride treatment: | Not covered |
| Office visit: | In-Network: $50.00 |
| Office visit: | Out-of-Network: $50 copay or 50-75% coinsurance |
| Oral exam: | Covered under office visit (limits may apply) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | In-Network: 20% coinsurance |
| Diagnostic radiology services (e.g., MRI): | Out-of-Network: 30% coinsurance |
| Diagnostic tests and procedures: | In-Network: 20% coinsurance (authorization required) |
| Diagnostic tests and procedures: | Out-of-Network: 20% coinsurance (authorization required) |
| Lab services: | In-Network: $0-5 copay or 0-20% coinsurance (authorization required) |
| Lab services: | Out-of-Network: 20% coinsurance (authorization required) |
| Outpatient x-rays: | In-Network: $12 copay |
| Outpatient x-rays: | Out-of-Network: 30% coinsurance |
Doctor visits
| Primary: | In-Network: $0 copay |
| Primary: | Out-of-Network: 30% coinsurance per visit |
| Specialist: | In-Network: $50 copay per visit |
| Specialist: | Out-of-Network: 30% coinsurance per visit |
Emergency care/Urgent care
| Emergency: | $90 copay per visit (always covered) |
| Urgent care: | $45 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | In-Network: $45 copay |
| Foot exams and treatment: | Out-of-Network: 30% coinsurance |
| Routine foot care: | Not covered |
Ground ambulance
| In-Network: $295 copay | |
| Out-of-Network: $295 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: Yes |
Hearing
| Fitting/evaluation: | In-Network: $0 copay (limits may apply) (referral required) |
| Fitting/evaluation: | Out-of-Network: 30% coinsurance (limits may apply) (referral required) |
| Hearing aids: | In-Network: $495-2,095 copay (limits may apply) |
| Hearing aids: | Out-of-Network: $495-2,095 copay (limits may apply) |
| Hearing exam: | In-Network: $45 copay (referral required) |
| Hearing exam: | Out-of-Network: 30% coinsurance (referral required) |
Hospital coverage (inpatient)
| In-Network: $395 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) | |
| Out-of-Network: 30% per stay (authorization required) |
Hospital coverage (outpatient)
| In-Network: $0-350 copay per visit (authorization required) | |
| Out-of-Network: 30% coinsurance per visit (authorization required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $9,500 In and Out-of-network $7,000 In-network |
Medical equipment/supplies
| Diabetes supplies: | In-Network: 20% coinsurance per item |
| Diabetes supplies: | Out-of-Network: 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 30% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 30% coinsurance per item |
Medicare Part B drugs
| Chemotherapy: | In-Network: 20% coinsurance |
| Chemotherapy: | Out-of-Network: 20% coinsurance |
| Other Part B drugs: | In-Network: 20% coinsurance |
| Other Part B drugs: | Out-of-Network: 20% coinsurance |
Mental health services
| Inpatient hospital – psychiatric: | In-Network: $230 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) |
| Inpatient hospital – psychiatric: | Out-of-Network: 30% per stay (authorization required) |
| Outpatient group therapy visit with a psychiatrist: | In-Network: $25 copay |
| Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance |
| Outpatient group therapy visit: | In-Network: $25 copay |
| Outpatient group therapy visit: | Out-of-Network: 30% coinsurance |
| Outpatient individual therapy visit with a psychiatrist: | In-Network: $25 copay |
| Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance |
| Outpatient individual therapy visit: | In-Network: $25 copay |
| Outpatient individual therapy visit: | Out-of-Network: 30% coinsurance |
Optional supplemental benefits
| No |
Preventive care
| In-Network: $0 copay | |
| Out-of-Network: 30% coinsurance |
Rehabilitation services
| Occupational therapy visit: | In-Network: $40 copay |
| Occupational therapy visit: | Out-of-Network: 30% coinsurance |
| Physical therapy and speech and language therapy visit: | In-Network: $40 copay |
| Physical therapy and speech and language therapy visit: | Out-of-Network: 30% coinsurance |
Skilled Nursing Facility
| In-Network: $0 per day for days 1 through 20 $178 per day for days 21 through 100 (authorization required) | |
| Out-of-Network: 30% per stay (authorization required) |
Transportation
| Not covered |
Vision
| Contact lenses: | In-Network: $0 copay |
| Contact lenses: | Out-of-Network: $0 copay |
| Eyeglass frames: | In-Network: $0 copay |
| Eyeglass frames: | Out-of-Network: $0 copay |
| Eyeglass lenses: | In-Network: $0 copay |
| Eyeglass lenses: | Out-of-Network: $0 copay |
| Eyeglasses (frames and lenses): | In-Network: $0 copay |
| Eyeglasses (frames and lenses): | Out-of-Network: $0 copay |
| Other: | Not covered |
| Routine eye exam: | In-Network: $0 copay (limits may apply) |
| Routine eye exam: | Out-of-Network: 30% coinsurance (limits may apply) |
| Upgrades: | In-Network: $0 copay |
| Upgrades: | Out-of-Network: $0 copay |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Ready to sign up for Martin’s Point Generations Advantage Flex (Regional 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