2022 Martins Point Generations Advantage Prime (HMO-POS)

Martins Point Generations Advantage Prime (HMO-POS) H5591-006 is a 2022 Medicare Advantage Plan or Part-C by Martins Point Generations Advantage available to residents in Maine. This plan includes additional prescription drug (Part-D) coverage. The Martins Point Generations Advantage Prime (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,500 out-of-pocket. This can be a extremely nice safety net.

Martins Point Generations Advantage Prime (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

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 Prime (HMO-POS) 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 Prime (HMO-POS) Part-C Premium

Martins Point Generations Advantage charges a $0.00 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.

H5591-006 Part-D Deductible and Premium

Martins Point Generations Advantage Prime (HMO-POS) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Martins Point Generations Advantage plan offers a $0.00 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 $0.00 . 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.

H5591-006 Formulary or Drug Coverage

Martins Point Generations Advantage Prime (HMO-POS) 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 Prime (HMO-POS) H5591-006 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$4
Tier 2	$10	$18
Tier 3	$40	$47
Tier 4	$95	$100
Tier 5	33%	33%

*Initial Coverage Phase and 30 day supply

2021 Martins Point Generations Advantage Prime (HMO-POS) 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
Endodontics	$50 copay or 50% coinsurance
Extractions	$50 copay or 50% coinsurance
Non-routine services	$50 copay or 50% coinsurance
Periodontics	$50 copay or 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	$50 copay or 50% coinsurance
Restorative services	$50 copay or 50% coinsurance

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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	0-15% coinsurance (Out-of-Network)
Diagnostic tests and procedures	0-15% coinsurance
Lab services	$0-5 copay or 0-20% coinsurance (Out-of-Network)
Lab services	$0-5 copay or 0-20% coinsurance
Outpatient x-rays	15% coinsurance
Outpatient x-rays	15% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$35 copay per visit (Out-of-Network)
Primary	$0 copay
Specialist	$40 copay per visit
Specialist	$55 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$40 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40 copay
Foot exams and treatment	$55 copay (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	$0 copay
Hearing aids	$495-1,095 copay
Hearing exam	$55 copay (Out-of-Network)
Hearing exam	$40 copay

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Inpatient Hospital Coverage

$375 per day for days 1 through 5 $0 per day for days 6 through 90
Not Applicable (Out-of-Network)

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Medical Equipment/Supplies

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

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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	$220 per day for days 1 through 7 $0 per day for days 8 through 90
Inpatient hospital - psychiatric	Not Applicable (Out-of-Network)
Outpatient group therapy visit	$30 copay (Out-of-Network)
Outpatient group therapy visit	$25 copay
Outpatient group therapy visit with a psychiatrist	$25 copay
Outpatient group therapy visit with a psychiatrist	$30 copay (Out-of-Network)
Outpatient individual therapy visit	$25 copay
Outpatient individual therapy visit	$30 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$25 copay
Outpatient individual therapy visit with a psychiatrist	$30 copay (Out-of-Network)

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MOOP

$7,050 In and Out-of-network $7,050 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
$400 copay per visit (Out-of-Network)

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Preventive Care

$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	$50.00
Oral exam	Covered under office visit

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Rehabilitation Services

Occupational therapy visit	$55 copay (Out-of-Network)
Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$55 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100
Not Applicable (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Upgrades	$0 copay

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Martins Point Generations Advantage Prime (HMO-POS) H5591

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 Prime (HMO-POS) Plans Performance

Health Plan Customer Service Rating for Martins Point Generations Advantage Prime (HMO-POS)

Martins Point Generations Advantage Prime (HMO-POS) 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?

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

Coverage Area for Martins Point Generations Advantage Prime (HMO-POS)

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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.