Each year the federal agency that administers Medicare—the Centers for Medicare & Medicaid Services—rates all Medicare Advantage plans on quality and performance. A 5-star rating is the highest rating possible from Medicare.
These ratings help our members and other Medicare beneficiaries know how good a job our plan is doing. You can use these Star Ratings to compare our plans' performance to other plans' performance using the Medicare Plan Finder tool.
For 2023, our Generations Advantage Prime (HMO-POS), Value Plus (HMO), Alliance (HMO), and Focus DC (HMO SNP) plans received a 5-Star Overall Rating from Medicare. In New Hampshire, these are the only plans to receive 5 Stars!1
For 2023, our Generations Advantage Select (LPPO) plan earned a 4.5-Star Overall Rating from Medicare.1
For more rating information on the Generations Advantage Prime, Value Plus, Alliance, and Focus DC plans, see our CMS Plan Ratings Sheet for the Prime, Value Plus, Alliance, and Focus DC plans.
For rating information on the Generations Advantage Select plan, please see our CMS Plan Ratings Sheet for the Select plan.
1 Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
HMO Contract #H5591 (Generations Advantage Prime, Value Plus, Alliance, and Focus DC) earned 5 stars in 2022. LPPO Contract #H1365 (Generations Advantage Select) earned 5 stars in 2022.
Each year the federal agency that administers Medicare—the Centers for Medicare & Medicaid Services—rates all Medicare Advantage plans on quality and performance. A 5-star rating is the highest rating possible from Medicare.
These ratings help our members and other Medicare beneficiaries know how good a job our plan is doing. You can use these Star Ratings to compare our plans' performance to other plans' performance using the Medicare Plan Finder tool.
For 2022, our Generations Advantage Prime (HMO-POS), Value Plus (HMO), Alliance (HMO), and Focus DC (HMO SNP) plans received a 5-Star Overall Rating from Medicare. In New Hampshire, these are the only plans to receive 5 Stars!1
For 2022, our Generations Advantage Select (LPPO) plan earned a 5-Star Overall Rating from Medicare.1
For 2022, our Generations Advantage Flex (RPPO) plan earned a 4-Star Overall Rating from Medicare. 1
For more rating information on the Generations Advantage Prime, Value Plus, Alliance, and Focus DC plans, see our
CMS Plan Ratings Sheet for the Prime, Value Plus, Alliance, and Focus DC plans.
For rating information on the Generations Advantage Select plan, please see our
CMS Plan Ratings Sheet for the Select plan.
For rating information on the Generations Advantage Flex plan, please see our
CMS Plan Ratings Sheet for the Flex plan.
1Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
HMO Contract #H5591 (Generations Advantage Prime, Value Plus, Alliance, and Focus DC) earned 5 stars in 2021. LPPO Contract #H1365 (Generations Advantage Select) earned 4.5 stars in 2021. RPPO Contract #R0802 (Generations Advantage Flex) was too new to be measured for 2021.
Martin’s Point Health Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Martin’s Point Health Care does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Martin’s Point Health Care:
If you need these services, contact the Martin's Point Generations Advantage Grievance Department.
If you believe that Martin’s Point Health Care has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Grievance Department
Martin’s Point Generations Advantage
PO Box 9746
Portland, ME 04104-8832
Phone: 1-866-544-7504, TTY: 711
Fax: 207-828-7874
You can file a grievance in person, by mail, or by fax. If you need help filing a grievance, the Martin’s Point Generations Advantage Grievance Specialist is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019 (TDD: 1-800-537-7697)
Complaint forms are available at https://www.hhs.gov/hipaa/filing-a-complaint/index.html
Multi-language Interpreter Service (PDF)
At Martin’s Point, we are committed to providing our members a fair and timely process for resolving any complaints or disputes. We encourage Martin’s Point Generations Advantage members to contact us with questions, concerns, or problems related to any benefits or service.
Please call us at 1-866-544-7504 (TTY: 711), 8 am to 8 pm, seven days a week from October 1–March 31, and Monday through Friday the rest of the year, to discuss your concerns.
Federal law guarantees our members’ rights to make complaints regarding concerns or problems with any part of the plan. The Medicare program has helped set the rules about what’s needed to make a complaint, and what we have to do when we receive a complaint. If a complaint is filed, we must be fair in how we handle it. As a Martin’s Point Generations Advantage member, you may not be disenrolled from your plan or penalized in any way for making a complaint.
For more information on coverage determinations, including exceptions, grievances, and appeals processes, please see the Evidence of Coverage for your plan. For Prime (HMO-POS), Flex (RPPO), Select (LPPO), Value Plus (HMO), and Focus DC (HMO SNP) plans, look at Chapter 9 of the Evidence of Coverage. For Value (HMO) plan, see Chapter 7 of the Evidence of Coverage. You can access the Evidence of Coverage for your plan on the plan detail page.
You are entitled to obtain an aggregate number of grievances, appeals, and exceptions filed with Martin's Point Generations Advantage.
You may do so by filing a written request with Martin's Point Generations Advantage and sending it to:
Martin's Point Generations Advantage Grievance Department.
PO Box 9746
Portland, ME 04104
To get more information on your plan and benefits, please see the Evidence of Coverage document on your plan detail page:
2023 PLANS |
2022 PLANS |
---|---|
Prime (HMO-POS) | Prime (HMO-POS) |
Alliance (HMO) | Flex (RPPO) |
Value Plus (HMO) | Alliance (HMO) |
Select (LPPO) | Value Plus (HMO) |
Focus DC (HMO SNP) | Select (LPPO) |
Focus DC (HMO SNP) |
As a Martin’s Point Generations Advantage member, you have a right to file a complaint if you think you aren’t getting quality service from us or you have quality of care issues with a plan provider.
This type of complaint is called a “grievance.” It is a formal complaint or dispute you have with Martin’s Point Generations Advantage or one of our plan providers.
There could be many reasons, such as:
You or your authorized representative may file a formal grievance either verbally or in writing by contacting our Member Services department or mailing your request to Martin’s Point Generations Advantage.
To file a grievance verbally, please call us at 1-866-544-7504 (TTY: 711). We are available 8 am–8 pm, seven days a week from October 1 to March 31; and Monday through Friday the rest of the year.
You can mail your written grievance to:
Martin’s Point Generations Advantage
Grievances
PO Box 9746
Portland, ME, 04104-9861
If your request for a fast appeal (sometimes called, an “expedited organization determination” or “expedited reconsideration”) is denied by Martin’s Point Generations Advantage, you have the right to submit a fast grievance request.
If you file a fast grievance, our Grievance Coordinator will respond to your request within 24 hours.
The parties who may request a standard or expedited redetermination include an enrollee, an enrollee’s representative, or an enrollee's prescribing physician or other prescriber.
If you are appointing a representative, the Medicare Appointment of Representative form (PDF) is required to be sent in with the appeal.
As a Martin’s Point Generations Advantage member, you have the right to ask us to reconsider our decisions. An appeal is a formal complaint or dispute regarding our decision not to pay for, not to provide, or to stop paying for or providing an item or service that you believe is needed.
When you file an appeal, you are asking us to reconsider and change an initial decision (also called an "initial organization determination") we have made about what services we will cover for you. An appeal can also be called a “request for reconsideration.”
The appeals process would apply in situations such as:
If you file a standard appeal request for care or treatment that you have not yet received, it will be processed within 30 calendar days of receiving your appeal. However, if your request is for a decision about care that you have already received, your appeal request will be processed within 60 calendar days of receiving your request. If either you or we find that some information is missing which can help you, we can take up to 14 more calendar days to make our decision.
When making an appeal the first level of appeal is with the plan. We review the coverage decision we have made to check to see if we are following all of the rules properly.
Your appeal is handled by different reviewers than those who made the original unfavorable decision. If we say no to all or part of your Level 1 appeal, you can go on to a Level 2 Appeal.
The Level 2 Appeal is conducted by an independent organization that is not connected to us. (In some situations, your case will be automatically sent to the independent organization for a Level 2 Appeal. If this happens, we will let you know. In other situations, you will need to ask for a Level 2 Appeal.)
If you are not satisfied with the decision at the Level 2 Appeal, you may be able to continue through additional levels of appeal. Whether you can take the next step may depend on the dollar value of the requested service.
The parties who may request a standard or expedited redetermination include an enrollee, an enrollee’s representative, or an enrollee's prescribing physician or other prescriber. If you are appointing a representative, the Medicare Appointment of Representative form (PDF) is required to be sent in with the appeal.
Your appeal must be made in writing. Simply mail or fax us a letter indicating what it is you would like to appeal, along with any documents that support your appeal, such as a copy of a bill you are receiving, medical records, or pictures of your injury.
You must request your appeal no later than 60 days following our original denial of coverage unless you have good cause for us to open a case beyond 60 days. Some good cause reasons include a serious illness that would have prevented you from filing on time, death or serious illness in your immediate family, an accident that caused your records to be destroyed, among others.
Please fax your request to us at: 207-828-7874.
Please mail your request to us at:
Martin’s Point Generations Advantage Appeals Department
P.O. Box 8832
Portland, ME 04104-9861
You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 30 days for a decision. If your request to expedite is granted, we must give you a decision no later than 72 hours after we get your physician’s supporting statement.
For more information about expedited appeals, please call the Generations Advantage Member Services team.
An enrollee, enrollee’s representative or enrollee’s prescribing physician or other prescriber may request a standard redetermination by filing a written request with the Part D plan sponsor.
The request must be filed within 60 calendar days from the date printed or written on the written coverage determination denial notice.
The request may be verbal, by calling our office, or in writing by mailing it to:
CVS Caremark–Martin’s Point Generations Advantage
Medicare Appeals Department
MC109
PO Box 52000
Phoenix, AZ 85072-2000
Or by faxing to 1-855-633-7673
You can also use our Redetermination form (PDF). You are not required to use this form but it may be a helpful guide.