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Evidence of Coverage

The Evidence of Coverage document gives you the details of your health plan benefits.

This document explains your benefits and rights—including medical and prescription drug coverage, services, and extra benefits as a member of a Martin's Point Generations Advantage plan from January 1–December 31, 2025. 


Use this document to learn about the following:
  • Your plan premium and cost sharing;
  • Your medical and prescription drug benefits;
  • How to file a complaint if you are not satisfied with a service or treatment;
  • How to contact us if you need assistance; and,
  • Other protections required by Medicare law.


Have questions? We’re here to help.

Talk to a health plan specialist 8 am–8 pm, Monday - Friday.

Enroll:
1-877-547-7053 
(TTY: 711)

Current Members:
1-866-544-7504

Prime (HMO-POS)

Evidence of Coverage—Prime H5591-015-001 [PDF]
Maine Counties: Lincoln, Oxford, Piscataquis, Somerset, Waldo | New Hampshire Counties: Belknap, Carroll, Coos Grafton

Evidence of Coverage—Prime H5591-015-002 [PDF]
Maine Counties: Aroostook, Franklin, Hancock, Knox, Penobscot Washington

Evidence of Coverage—Prime H5591-005 [PDF]
New Hampshire Counties: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan

Evidence of Coverage—Prime H5591-006-001 [PDF]
Maine Counties: Cumberland and York

Evidence of Coverage—Prime H5591-006-002 [PDF]
Maine Counties: Androscoggin, Kennebec, Sagadahoc

Select (LPPO)

Evidence of Coverage—Select H1365-001 [PDF]
Maine Counties: Androscoggin, Aroostook, Cumberland, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, Washington, York
New Hampshire Counties: Cheshire, Coos, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan

Value Plus (HMO-POS)

Evidence of Coverage—Value Plus H5591-009 [PDF]
All Maine Counties

Access (LPPO)

Evidence of Coverage—Access H1365-004-002 [PDF]
New Hampshire Counties: Belknap, Carroll, Coos, Grafton

Evidence of Coverage—Access H1365-004-003 [PDF]
New Hampshire Counties: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan

Alliance (HMO)

Evidence of Coverage—Alliance H5591-003 [PDF]
All Counties in Maine and New Hampshire