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  • For Members & Patients

Evidence of Coverage

The Evidence of Coverage document gives you the details of your Medicare health benefits, services, and prescription drug coverage as a member of a Martin's Point Generations Advantage plan from January 1–December 31, 2024.

This document explains your benefits and rights. 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)

H5591-015-001 - Lincoln, Oxford, Piscataquis, Somerset, Waldo Counties in Maine. For Belknap, Carroll, Coos and Grafton Counties in New Hampshire (PDF)

H5591-015-002 - Aroostook, Franklin, Hancock, Knox, Penobscot and Washington Counties in Maine (PDF)

H5591-005 - Cheshire, Hillsborough, Merrimack, Rockingham, Strafford and Sullivan Counties in New Hampshire (PDF)

H5591-006-001 - Cumberland County in Maine (PDF)

H5591-006-002 - Kennebec and Sagadahoc Counties in Maine (PDF)

H5591-006-004 - York County in Maine (PDF)

H5591-006-005 - Androscoggin County in Maine (PDF)


ALLIANCE (HMO)

H5591-003 - All Counties in Maine and New Hampshire (PDF)


VALUE PLUS (HMO-POS)

H5591-009 - Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington Counties in Maine (PDF)

H5591-013 - Kennebec and Sagadahoc Counties in Maine (PDF)


SELECT (LPPO)

H1365-001 - Androscoggin, Aroostook, Cumberland, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, Washington and York Counties in Maine, and Cheshire, Coos, Hillsborough, Merrimack, Rockingham, Strafford and Sullivan Counties in New Hampshire (PDF)


ACCESS (LPPO)

H1365-004-002 - Belknap, Carroll, Grafton and Coos Counties in New Hampshire (PDF)

H1365-004-003 - Cheshire, Hillsborough, Merrimack, Rockingham, Strafford and Sullivan Counties in New Hampshire (PDF)

 

Expand All

PRIME (HMO-POS)

For Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties in Maine and Belknap, Carroll, Coos, Grafton counties in New Hampshire (PDF) 

For Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties in Maine and Cheshire, Hillsborough, Merrimack Rockingham, Strafford, Sullivan Counties in New Hampshire (PDF)


ALLIANCE (HMO)

For all counties in Maine and New Hampshire (PDF)


VALUE PLUS (HMO)

Aroostook, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo and Washington counties in Maine (PDF)


SELECT (LPPO)

For Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Piscataquis, Sagadahoc, Waldo, and York counties in Maine; Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan counties in New Hampshire (PDF)

Aroostook, Hancock, Kennebec, Penobscot, Somerset and Washington counties in Maine and Coos county in New Hampshire

For Belknap, Carroll, and Grafton Counties in New Hampshire (PDF)


FOCUS DC (HMO SNP)

For Cumberland County in Maine (PDF)

Please contact our Member Services number at 1-866-544-7504 for additional information. (TTY users should call 711)