2024 Access (LPPO) Plan Details
Access plan members have all-in-one coverage, including medical, hospital, and Part D Prescription Drug coverage.
Below you will find a summary of your coverage and benefits as well as key documents and extra plan benefits.d
You can see out-of-network providers for most covered medical services, though you pay less for in-network providers.
Table of Contents:
Plan Benefit Overview
A look at your plan benefits, copays/costs, important documents, and more.
Medical Coverage
Generations Advantage Access (LPPO) Plan in-network coverage includes:
- No medical deductibles
- $0 annual routine physical and annual routine vision exam
- $0 copays for many preventive services
Out-of-Pocket Maximums: $5,900 / $9,550 combined in- and out-of-network (varies by county)
Primary Care Office Visit Copay: $5 / $10 (varies by county)
Specialist Office Visit Copay: $35 / $40 (varies by county)
Urgent Care Copay: $50 in-country and $120 out-of-country
Emergency Care Copay: $120 for both in- and out-of-country
Inpatient Hospital Stay Copay: $360 per day for days 1-7, and $0 per day for days 8+
Pharmacy & Part D
Your plan includes Medicare Part D Prescription Drug coverage.
Drug costs can vary by tier, source (where you fill your prescriptions), and by phase of coverage. More information can be found here in the Pharmacy & Prescription Resources section.
Is my prescription covered?
Each plan has its own formulary—a list of drugs covered by the plan. Members can use the Formulary Search Tool find coverage information for a specific medication:
Prefer a hard copy? Download a PDF copy of the Comprehensive Drug Formulary here:
Ready to get reimbursed? Download the 2024 Prescription Drug Reimbursement Form here to get started:
Prescription Reimbursement Form
Prescription Deductible: $275*
*Includes drugs in Tiers 3, 4, and 5
Prescription Copays: Below is a summary of drug copays with preferred, standard, and mail-order cost-sharing:
INSULIN COPAYS: Insulin copays are the same at all pharmacies (preferred, standard, and mail order):
Comprehensive Dental
The Martin’s Point Generations Advantage dental benefit is administered by Northeast Delta Dental (NEDD).
Expenses incurred by the plan for covered dental services accrue to your annual maximum benefit.
- Dental Deductible: $0
- Calendar Year Maximum*: $1,000 / $2,000
*Calendar year maximums vary by county
For a full breakdown of coverage by county, visit the Dental Benefit page.
*Certain counties do not have basic/major restorative coverage
Is my dentist in-network? You must use a Delta Dental network provider in Maine, New Hampshire, or Vermont.
To see if your dentist is in-network, or to find a dentist in your local area, use the search tool:
Eyewear & Vision Benefits
Your Martin’s Point Generations Advantage plan offers extra vision benefits that go beyond Original Medicare.
Coverage includes:
- Annual Routine Vision Exam: $0 copay for one exam per year (includes diabetic (dilated-pupil) eye exams)
- Eyewear Allowance*: Up to $150 / $250 per year
*Allowance amount varies by county
For a full breakdown of coverage by county, visit the Eyewear & Vision Benefits page for further information.
What is covered under the eyewear reimbursement benefit?
The eyewear reimbursement benefit covers prescription lenses, frames, and contact lenses. For more information, including a full list of covered items/services, go here:
Ready to get reimbursed? Download the 2024 Eyewear Reimbursement Form here to get started:
2024 Member Reimbursement Form
Eyewear After Cataract Surgery: If you've had recent cataract surgery, we've got you covered.
Learn more here: Eyewear After Cataract Surgery
Hearing Benefits
The Hearing Benefit goes beyond Original Medicare to provide coverage for hearing aids/batteries.
Generations Advantage members have an extra hearing benefit through Amplifon.
Members are required to use an Amplifon network provider to receive coverage. Amplifon will work with you to find a network provider in your local area.
*There is a 3-year warranty included for all hearing devices
Ready to get started?
Call Amplifon to get started at1-888-669-2167 (TTY: 711).
For more information, visit the Hearing Aid Benefit page.
Wellness Wallet Benefits
Use your Wellness Wallet to help you stay fit and healthy!
- Maximum Reimbursement: $425 per year
For more information, visit the Wellness Wallet page.
Does my item qualify for reimbursement?
The Wellness Wallet benefit reimburses you for a wide range of eligible gear, fees, and services.
A list of covered items/services and a breakdown of coverage by county can be found here:
Ready to get reimbursed? Download the 2024 Wellness Wallet Reimbursement Form here to get started:
Over-the-Counter Benefits
Members receive a quarterly amount to purchase from over 350 CVS-brand, over-the-counter products.
- Quarterly Allowance: $50 per quarter
Unused amounts DO NOT roll over into the next quarter.
For more information, visit the OTC Benefit page.
Purchases can be made in person at participating CVS retail locations, by phone, or online up to your plan's quarterly allowed amount.
What items are covered?
Members can use the OTC Catalog Search Tool to search for covered items online:
Prefer a hard copy? Members can download a PDF copy of the catalog here:
Extra Services & Programs
A quick guide to premium payments, health screenings, nutrition coaching, emergency care, and more.
Pay your Generations Advantage plan premium online.
One-Time Payment
It's easy to make a one-time credit card payment. Simply click the button below to securely pay your premium.
Recurring Monthly Payments
To set up secure, recurring payments, please call Member Services or mail us a completed and signed Automatic Payment Form.
Overview
Your free* annual flu shots can be administered at participating pharmacies** as well as by your primary care provider. Shots covered include quadrivalent, trivalent, trivalent (high dose), and intradermal.
- In-Network Pharmacy: Free at participating pharmacies including Hannaford, Rite Aid, CVS (including former Target pharmacies), Shaw’s/Osco, Walgreens, and Walmart.
- PCP/Doctor's Office: If you get the shot at your primary care provider’s office, you may have to pay a copayment for the office visit depending on your plan, but there will be no cost for the flu shot.
- Out-of-Network Pharmacy: If you get your flu shot at a pharmacy that is not in the Vaccine Pharmacy Network, it may still be covered by your plan. You will pay the full cost at the pharmacy and submit a form to us for reimbursement.
If you don’t show your Generations Advantage member ID card when you get your flu shot, you will pay the full cost at the pharmacy and submit a form to us for reimbursement.
Flu Shot Reimbursement Form (PDF)
If your pharmacist has problems sending your claim to us, they should call our Part D Pharmacy Help Desk at 1-800-364-6331
*Influenza (flu) vaccines are covered under your Medicare Part B benefit through your Generations Advantage plan.
**The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.
Overview
Martin’s Point Health Care has teamed up with Foodsmart™ to provide you with free, unlimited chats with a nutrition coach—plus much more—to support healthy eating from the comfort of home by telephone or online.
You don’t need to use your health plan’s Wellness Wallet reimbursement program to take advantage of this benefit as your Generations Advantage plan covers 100% of the program cost.
The Foodsmart program is tailored to your individual needs and preferences—from nutrition tips for managing a medical condition, to simply wanting to eat healthier, or just trying to save on groceries. Your Foodsmart nutrition coach and other resources can make healthy eating easier and more affordable.
To get started, call 1-888-837-5325 to schedule an appointment with a nutrition coach.
If you prefer to reach out online, you can:
- Visit https://www.foodsmart.com/martinspoint to sign up. If you are having difficulties signing up online, call 1-888-837-5325 for technical support
- Send an email requesting an appointment to [email protected]
- Download the Foodsmart app in the App Store or Google Play. Click on “Sign Up.” Your Group is “Martin’s Point Generations Advantage.”
Martin’s Point care management programs are entirely voluntary. You can choose not to participate or to stop participating in the program at any time. If you have immediate concerns regarding your health, please contact your doctor. Always consult your health care provider before making any lifestyle changes. Only your doctor can diagnose and treat a medical condition.
Members have the option to purchase nutritionally balanced, refrigerated, and ready-to-eat meals that are delivered by Mom’s Meals direct to your home.
- Martin’s Point Generations Advantage members will get free shipping on all orders (a savings of $14.95).
- Menus are designed by chefs and registered dietitians to support general wellness goals or the specific nutrition needs of common health conditions.
- Members can select every meal, every order from over 70 entrée options.
- Entrées are refrigerated and ready-to-eat after just two minutes in the microwave.
Place your order online or by phone using code MPGA to activate the offer:
Online: momsmeals.com/mpga
Phone: 1-877-347-3438
Value-Added Discount Overview
At Martin's Point, we’ve partnered with LifeStation to offer peace of mind and security through advanced medical alert devices. LifeStation ensures you're always connected when it matters most.
GENERATIONS ADVANTAGE DISCOUNT ON MEDICAL ALERT DEVICES
Generations Advantage plan members (Access, Select, Prime, and Value Plus) receive 25% discounts for medical alert devices through LifeStation. Please note, this is not a plan benefit and is instead a value-added discount.
How to Access Your Value-Added Discount:
- Dedicated web page: LifeStation Medical Alert - Martin's Point
- Call to Enroll: 1-855-793-8555
Speak directly with a LifeStation representative to enroll—no Generations Advantage ID required. - Payment information needed: Provide a credit card or bank account for automatic deductions of monthly charges for the device and monitoring.
What’s Covered:
- Shipping and activation fees
- Monthly charges for device and monitoring
- Note: Optional accessories, including a smartwatch, can be offered at additional rates.
Devices & Pricing:
- In-Home Landline: $19.95/month
- In-Home Mobile: $25.95/month
- Mobile with GPS: $29.95/month
- Fall Detection (optional add-on): $5.00/month
MANAGING YOUR LIFESTATION SERVICE
Once enrolled in either option, LifeStation makes it easy to manage your service and get support when you need it:
- Customer Service Number: 1-800-998-2400 for troubleshooting or to explore device add-ons.
Overview
As a Martin’s Point Generations Advantage member, you are eligible to receive FREE, personalized care management. Sign up for a dedicated medical or behavioral health care manager who will help you succeed at leading a healthy, active, and full life.
Our care managers can help you:
- Manage your health care
- Navigate your health plan
- Understand medications
- Find community support and resources
We want to help you live the healthiest life possible. Get started by calling a Martin’s Point care manager at 1-877-659-2403 or visit our Health Services page for more details.
Martin’s Point care management programs are entirely voluntary. You can choose not to participate or to stop participating in the program at any time. If you have immediate concerns regarding your health, please contact your doctor. Always consult your health care provider before making any lifestyle changes. Only your doctor can diagnose and treat a medical condition.
Overview
Talk with a trained nurse anytime, 24 hours a day, 7 days a week, to answer any questions about symptoms, injuries, or illness.
Call 1-800-530-1021 if you need to know:
- If a cut requires stitches
- If you should head to an urgent care clinic, the ER, or wait until morning to see your doctor
- General information about a condition, medication, or other health concerns
This service is provided by Carenet Health in partnership with Martin's Point. This service is not intended to take the place of your primary care provider.
*Every year, Medicare evaluates plans based on a 5-star rating system. Medicare’s highest 2025 rating awarded for MA (HMO, HMO-POS, LPPO) style plans in Maine and New Hampshire is 4 out of 5 stars. Generations Advantage 2025 Overall Ratings: 4 out of 5 Stars for HMO Contract #H5591 (includes HMO-POS) and 3 out of 5 Stars for LPPO Contract #H1365. Visit Medicare.gov for more information.