Martin’s Point Generations Advantage Value Plus (HMO-POS)

H5591 - 009 - 0

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Martin’s Point Generations Advantage Value Plus (HMO-POS) is a Medicare Advantage Plan by Martin’s Point Generations Advantage.

This page features plan details for 2025 Martin’s Point Generations Advantage Value Plus (HMO-POS) H5591 – 009 – 0 available in Northern, Central, Midcoast, and Southern Maine.

Locations

Martin’s Point Generations Advantage Value Plus (HMO-POS) is offered in the following locations.

Androscoggin County, Maine

Aroostook County, Maine

Cumberland County, Maine

Click to see more locations

Plan Overview

Martin’s Point Generations Advantage Value Plus (HMO-POS) offers the following coverage and cost-sharing.

Insurer:	Martin’s Point Generations Advantage
Health Plan Deductible:	–
MOOP:	$6,350.00 combined
Drugs Covered:	Yes

Ready to sign up for Martin’s Point Generations Advantage Value Plus (HMO-POS) ?

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 Value Plus (HMO-POS) 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 Value Plus (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$150.00
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 D	LIS Full
$0.00	$0.00

Initial Coverage Phase

After you pay your $150.00 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.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$4.00 Copay	$4.00 Copay
2) Generic		$10.00 Copay	$10.00 Copay
3) Preferred Brand	$42.00 Copay	$47.00 Copay	$47.00 Copay
4) Non-Preferred Drug	$95.00 Copay	$100.00 Copay	$100.00 Copay
5) Specialty Tier	31.00% Coinsurance	31.00% Coinsurance

60 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$8.00 Copay	$8.00 Copay
2) Generic		$20.00 Copay	$20.00 Copay
3) Preferred Brand	$84.00 Copay	$94.00 Copay	$94.00 Copay
4) Non-Preferred Drug	$190.00 Copay	$200.00 Copay	$200.00 Copay
5) Specialty Tier

90 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$12.00 Copay	$10.00 Copay
2) Generic		$30.00 Copay	$25.00 Copay
3) Preferred Brand	$126.00 Copay	$141.00 Copay	$117.50 Copay
4) Non-Preferred Drug	$285.00 Copay	$300.00 Copay	$250.00 Copay
5) Specialty Tier

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 Value Plus (HMO-POS) also provides the following benefits.

Cardiac and Pulmonary Rehabilitation Services

Authorization Required: Yes
Referral Required: No

Durable Medical Equipment, Prosthetics/Orthotics, and Medical Supplies

Prosthetics/Medical Supplies

Authorization Required: Yes
Preferred Vendors: No

Prosthetics/Orthotics – Orthotic Devices

Coinsurance: 20%

Prosthetics/Orthotics – Orthotic Devices

Coinsurance: 20%
Authorization Required: No
Specified Manufacturers: No
Limits Apply: No

Emergency and Urgent Care Services

Urgently Needed Services

Copay: $125.00
Enhanced Benefits: Worldwide Emergency Coverage; Worldwide Urgent Coverage; Worldwide Emergency Transportation
Waivers if Admitted: Yes

Worldwide Emergency Transportation

Copay: $125.00
Limits Apply: No

Eye Exams and Eye Wear Services

Eye Exams

Enhanced Benefits: Routine Eye Exams

Routine Eye Exams

Limits Apply: No

Eyewear

Copay: $0.00 – $45.00
Authorization Required: No
Referral Required: No
Enhanced Benefits: Contact lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Upgrades

Contact Lenses

Limits Apply: Yes

Eyeglasses (Lenses and Frames)

Limits Apply: Yes

Eyeglass Lenses

Limits Apply: Yes

Eyeglass Frames

Limits Apply: Yes

Eyewear Upgrades

Coinsurance: 20%

Health Care Professional Services

Chiropractic Services

Copay: $15.00
Authorization Required: No
Referral Required: No

Psychiatric Services – Inpatient Care

Copay: $25.00

Psychiatric Services – Outpatient Care

Copay: $25.00
Authorization Required: Yes

PT and SP Services

Copay: $10.00 – $45.00

Hearing Exams and Hearing Aids Services

Hearing Exams

Enhanced Benefits: Fitting/Evaluation for Hearing Aid

Fitting/Evaluation for Hearing Aid

Limits Apply: No

Hearing Aids

Copay: $45.00
Authorization Required: No
Referral Required: Yes
Enhanced Benefits: Hearing Aids (all types)

Hearing Aids (All Types)

Referral Required: No
Limits Apply: No

Home Health Services

Authorization Required: Yes
Referral Required: No

Inpatient Hospital Acute Services

Inpatient Hospital-Acute

Enhanced Benefits: Additional Days

Inpatient Acute Additional Days

Limits Apply: Yes

Inpatient Hospital-Acute

Authorization Required: Yes
Referral Required: No
Day Interval 1: $375.00 (Days 1 – 7)
Day Interval 2: $0.00 (Days 8 – 90)

Inpatient Hospital Psychiatric Services

Inpatient Hospital-Psychiatric

Authorization Required: Yes
Referral Required: No
Day Interval 1: $365.00 (Days 1 – 5)
Day Interval 2: $0.00 (Days 6 – 90)

Medicare Part B Prescription Drugs

Medicare Part B Drugs – Tier 2

Coinsurance: 0% – 20%

Medicare Part B Drugs – Tier 3

Coinsurance: 0% – 20%

Medicare Part B Drugs – Tier 1

Copay: $35.00
Authorization Required: Yes

Model Test

Mental Health Specialty Services – Tier 1

Copay: $0.00

Mental Health Specialty Services – Tier 2

Copay: $0.00

Psychiatric Services – Inpatient Care

Copay: $0.00

Psychiatric Services – Outpatient Care

Copay: $0.00

Outpatient Blood Services – Type 1

Copay: $0.00

Outpatient Blood Services – Type 2

Copay: $0.00

Non-Primarily Health Related Benefits for the Chronically Ill

Meals (Beyond limited basis)

Limits Apply: Yes

General Supports for Living

Authorization Required: Yes
Referral Required: Yes

Out-of-Network Data for PPO Plans

Outpatient Blood, Acupuncture, and Other Services

Acupuncture

Enhanced Benefits: Number of Treatments
Limits Apply: Yes

Other 3

Authorization Required: No
Referral Required: Yes

Outpatient Clinical, Diagnostic, and Therapeutic Radiology Services

Outpatient Diagnostic Procedures/Tests

Coinsurance: 0% – 15%

Outpatient Lab Services

Copay: $0.00 – $5.00
Coinsurance: 0% – 20%
Authorization Required: Yes
Referral Required: Yes

Outpatient Diagnostic Radiology

Coinsurance: 20%

Outpatient Therapeutic Radiology

Coinsurance: 20%

Outpatient X-Ray Services

Copay: $15.00

Outpatient Hospital, ASC, Substance Abuse, and Cardiac Rehabilitation Services

Outpatient Hospital Services – General

Copay: $0.00 – $320.00

Outpatient Hospital Services – Observation

Copay: $375.00
Authorization Required: Yes
Referral Required: No

Outpatient Blood Services – Type 1

Copay: $25.00

Outpatient Blood Services – Type 2

Copay: $25.00
Referral Required: Yes

Partial Hospitalization Services

Partial Hospitalization

Copay: $70.00
Authorization Required: Yes
Referral Required: No

Preventive Services (Health Education, Immunizations, Routine Physicals, Pap/Pelvic Exams)

Kidney Disease Education Services

Authorization Required: No
Referral Required: No

Other Defined Supplemental Benefits

Enhanced Benefits: 14c2: Nutritional/Dietary Benefit;14c4: Fitness Benefit*;14c7: Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)*;14c12: Medical Nutrition Therapy (MNT);14c15: Wigs for Hair Loss Related to Chemotherapy;14c16: Weight Management Programs*;14c17: Alternative Therapies*;

Nutritional/Dietary Benefit

Limits Apply: Yes

Alternative Therapies

Authorization Required: Yes
Limits Apply: Yes

Diabetes Self-Management Training – Level 1

Authorization Required: No

Diabetes Self-Management Training – Level 2

Authorization Required: No

Diabetes Self-Management Training – Level 3

Authorization Required: No

Diabetes Self-Management Training – Level 4

Authorization Required: No

Diabetes Self-Management Training – Level 5

Authorization Required: No
Referral Required: No

Renal Dialysis Services

Dialysis Services

Coinsurance: 20%
Authorization Required: Yes
Referral Required: No

Skilled Nursing Facility (SNF) Services

SNF Medicare-covered stay

Authorization Required: Yes
Referral Required: No
Day Interval 1: $10.00 (Days 1 – 20)
Day Interval 2: $214.00 (Days 21 – 100)

Supplemental Benefits Preventive Services

Other Defined Supplemental Benefits

Enhanced Benefits: 14c18: Therapeutic Massage;

Therapeutic Massage

Authorization Required: No
Referral Required: Yes
Limits Apply: Yes

Other Defined Supplemental Benefits

Enhanced Benefits: 14c1: Health Education;14c8: Home and Bathroom Safety Devices and Modifications*;

Home and Bathroom Safety Devices and Modifications

Authorization Required: No
Referral Required: No

Ready to sign up for Martin’s Point Generations Advantage Value Plus (HMO-POS) ?

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