2024 Alliance (HMO) Plan Details
THE 2024 ALLIANCE PLAN IS AMONG THE HIGHEST RATED MEDICARE ADVANTAGE PLANS IN MAINE AND NEW HAMPSHIRE!*
Alliance plan members have comprehensive medical and hospital coverage, plus rich extra benefits.
The Alliance plan does not offer Part D Prescription Drug coverage. With this plan you must use in-network providers for all plan services except for out-of-area urgent and emergency care.
Below you will find a summary of your coverage and benefits as well as key documents and extra plan benefits.d
Table of Contents:
Plan Benefit Overview
A look at your plan benefits, copays/costs, important documents, and more.
BENEFIT OVERVIEW
Generations Advantage Alliance (HMO) 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: $5,000 in-network
PRIMARY CARE OFFICE VISIT COPAY: $0
SPECIALIST OFFICE VISIT COPAY: $5
URGENT CARE COPAY: $0 in-country | $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+
NOTE: The Alliance plan DOES NOT include Medicare Part D Prescription Drug coverage.
DENTAL BENEFITS
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: $2,500
For more information, visit the Dental Benefit page.
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 $300 per year
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: $450 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 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: $100 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. Click the button below to use the PayTrace service to make your secure payment.
Recurring Monthly Payments
To set up secure, recurring payments, please call Member Services or mail us a completed and signed Automatic Payment Form.
Overview
Colorectal cancer screenings save lives. All screenings have a $0 copay when you go to an in-network provider. Ask your primary care provider which screening and schedule is right for you. We cover these screenings more frequently for people at high risk for colorectal cancer.
Overview
Covers routine (maintenance) chiropractic services and office visits for a $20 copay.
Routine services may include:
- Conservative management of neuromusculoskeletal disorders
- Related functional clinical conditions including, but not limited to, back pain, neck pain, and headaches
Services must be received from a state-licensed chiropractor practicing within the state’s licensure and practice guidelines.
X-rays are not covered when rendered in a chiropractor’s office.
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.
Overview
The Alliance plan offers a $0 copay for medical alert devices through LifeStation.
LifeStation details:
- Choose an in-home system (landline or cellular that can be used only in the home), LifeStation Smartwatch, or a mobile system with location services which can be used outside of the home
- Fall-detection option available (automatically alerts LifeStation that you have fallen, even if you do not press the emergency button)
- Product warranty on all service plans
- Spousal coverage available on all in-home units
- Additional cost for a device protection plan may apply
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.
Overview
When you need medical care quickly, it's good to know you have a wide range of quality options to choose from, depending on how severe your condition or injury may be.
If you feel your condition is life-or-limb threatening, the emergency room is always the right choice. If not, we recommend your PCP or an urgent-care clinic—you could save time and money, while receiving excellent care from highly-trained medical professionals.
*Members must use in-network providers for most services.
Bathroom Safety
Allowance for bathroom safety devices and installation:
- You receive a $400 allowance for bathroom safety devices, including shower seats, safety bars, transfer benches, and other items
- Covers installation of devices and an in-home bathroom safety inspection by a qualified health professional to identify the need for safety devices and the applicability to your bathroom
The $400 allowance is available for ALL Alliance plan members. However, there are some clinically-nuanced benefits that will require a specific diagnosis—please see the Evidence of Coverage for your plan or call Member Services for further details regarding coverage.
Meal Delivery
Administered by Mom's Meals
Receive home-delivered meals tailored to your individual health and dietary needs after an inpatient stay or surgery:
- Meals are fully prepared and ready to go in the refrigerator when they arrive on your doorstep.
- You pay nothing for up to three weeks (42 meals) per inpatient stay or surgery (no maximum per year).
Call Martin's Point Care Management for more information 1-877-659-2403.
Smoking Cessation
You pay $0 for two additional smoking cessation classes beyond what Medicare covers.
Health Education
All plan members qualify for health coaching, disease support groups, and nutritional cooking classes.
Call Member Services for more information 1-866-544-7504.
Counseling
You pay $0 for one counseling visit per year for counseling services not covered by Original Medicare.
Session can be individual or group therapy services to address non-Medicare-covered general topics, such as: coping with life changes, conflict resolution, or grief counseling
*Every year, Medicare evaluates plans based on a 5-star rating system. Medicare’s highest 2024 rating awarded for MA (HMO, HMO-POS, LPPO) style plans in ME and NH is 4.5 out of 5 stars. Generations Advantage 2024 Overall Ratings: 4.5 out of 5 Stars for HMO Contract H5591 (includes HMO-POS) and LPPO Contract H1365. Visit www.Medicare.gov for more information.