Evidence of Coverage
The Evidence of Coverage document gives you the details of your Medicare health 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.
Prime (HMO-POS)
H5591-015-002 - Aroostook, Franklin, Hancock, Knox, Penobscot and Washington Counties in Maine (PDF)
H5591-006-001 - Cumberland and York County in Maine (PDF)
H5591-006-002 - Androscoggin, Kennebec and Sagadahoc Counties in Maine (PDF)
Alliance (HMO)
H5591-003 - All Maine Counties and All New Hampshire Countiess (PDF)
Value Plus (HMO-POS)
H5591-009 - All Maine Counties (PDF)
Select (LPPO)
Access (LPPO)
H1365-004-002 - Belknap, Carroll, Coos, and Grafton Counties in New Hampshire (PDF)
Prime (HMO-POS)
H5591-015-002 - Aroostook, Franklin, Hancock, Knox, Penobscot and Washington Counties in Maine (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)
H5591-013 - Kennebec and Sagadahoc Counties in Maine (PDF)
Select (LPPO)
Access (LPPO)
H1365-004-002 - Belknap, Carroll, Grafton and Coos Counties in New Hampshire (PDF)