2022 Martins Point Generations Advantage Flex (Regional PPO)

Martins Point Generations Advantage Flex (Regional PPO) R0802-001 is a 2022 Medicare Advantage Plan or Part-C by Martins Point Generations Advantage available to residents in Maine and New Hampshire. This plan includes additional prescription drug (Part-D) coverage. The Martins Point Generations Advantage Flex (Regional PPO) has a monthly premium of $53.00 and has an in-network maximum out-of-pocket limit of $7,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,000 out-of-pocket. This can be a extremely nice safety net.

Martins Point Generations Advantage Flex (Regional PPO) is a Regional PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Martins Point Generations Advantage works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Martins Point Generations Advantage Flex (Regional PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Martins Point Generations Advantage and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Martins Point Generations Advantage except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Martins Point Generations Advantage Medicare Advantage Plan Costs

Martins Point Generations Advantage Flex (Regional PPO) Part-C Premium

Martins Point Generations Advantage charges a $35.10 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

R0802-001 Part-D Deductible and Premium

Martins Point Generations Advantage Flex (Regional PPO) has a monthly drug premium of $17.90 and a $275.00 drug deductible. This Martins Point Generations Advantage plan offers a $17.90 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Martins Point Generations Advantage above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $17.90 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Martins Point Generations Advantage Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Martins Point Generations Advantage plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Martins Point Generations Advantage Flex (Regional PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $4.50 for 75% low income subsidy $8.90 for 50% and $13.40 for 25%.

R0802-001 Formulary or Drug Coverage

Martins Point Generations Advantage Flex (Regional PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Martins Point Generations Advantage Flex (Regional PPO) R0802-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$2	$4
Tier 2	$10	$18
Tier 3	$40	$47
Tier 4	$95	$100
Tier 5	28%	28%

*Initial Coverage Phase and 30 day supply

2021 Martins Point Generations Advantage Flex (Regional PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

Yes

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Comprehensive Dental

Diagnostic services	$50 copay or 50% coinsurance
Diagnostic services	$50 copay or 50-75% coinsurance (Out-of-Network)
Endodontics	$50 copay or 50-75% coinsurance (Out-of-Network)
Endodontics	$50 copay or 50% coinsurance
Extractions	$50 copay or 50-75% coinsurance (Out-of-Network)
Extractions	$50 copay or 50% coinsurance
Non-routine services	$50 copay or 50% coinsurance
Non-routine services	$50 copay or 50-75% coinsurance (Out-of-Network)
Periodontics	$50 copay or 50-75% coinsurance (Out-of-Network)
Periodontics	$50 copay or 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	$50 copay or 50-75% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$50 copay or 50% coinsurance
Restorative services	$50 copay or 50% coinsurance
Restorative services	$50 copay or 50-75% coinsurance (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	20% coinsurance
Diagnostic tests and procedures	20% coinsurance (Out-of-Network)
Lab services	20% coinsurance (Out-of-Network)
Lab services	$0-5 copay or 0-20% coinsurance
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$12 copay

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Doctor Visits

Primary	30% coinsurance per visit (Out-of-Network)
Primary	$0 copay
Specialist	$50 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$45 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$45 copay
Foot exams and treatment	30% coinsurance (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$295 copay (Out-of-Network)
$295 copay

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Hearing

Fitting/evaluation	30% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$495-1,095 copay
Hearing aids	$495-1,095 copay (Out-of-Network)
Hearing exam	$45 copay
Hearing exam	30% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

30% per stay (Out-of-Network)
$395 per day for days 1 through 5 $0 per day for days 6 through 90

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Medical Equipment/Supplies

Diabetes supplies	20% coinsurance per item (Out-of-Network)
Diabetes supplies	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	20% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	20% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$230 per day for days 1 through 7 $0 per day for days 8 through 90
Outpatient group therapy visit	$25 copay
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$25 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$25 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$25 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

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MOOP

$8,000 In and Out-of-network $5,500 In-network

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Option

Yes, contact plan for further details

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$0-350 copay per visit
30% coinsurance per visit (Out-of-Network)

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Preventive Care

30% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	Covered under office visit
Dental x-ray(s)	Covered under office visit
Fluoride treatment	Not covered
Office visit	$50 copay or 50-75% coinsurance (Out-of-Network)
Office visit	$50.00
Oral exam	Covered under office visit

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay

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Skilled Nursing Facility

30% per stay (Out-of-Network)
$0 per day for days 1 through 20 $178 per day for days 21 through 100

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Transportation

Not covered

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Vision

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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Martins Point Generations Advantage Flex (Regional PPO) R0802

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Martins Point Generations Advantage Flex (Regional PPO) Plans Performance

Health Plan Customer Service Rating for Martins Point Generations Advantage Flex (Regional PPO)

Martins Point Generations Advantage Flex (Regional PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Martins Point Generations Advantage Flex (Regional PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.