Understanding Medicare: Get the Care You Need, Wherever You Are

Posted 01/10/24

When it comes to Medicare Advantage plans, getting coverage for medical care beyond your home base can create a lot of confusion. Too often, this lack of understanding leads people to overpay, miss out on benefits, and pass up the local, friendly service they deserve. We’d like to dispel some common myths about out-of-network coverage, so you have the facts you need to choose the best health plan for your needs.

Myth: Frequent Traveler’s Dilemma

I live in Maine, but my wife and I travel a lot. We can’t join a Martin’s Point Generations Advantage plan because we might need urgent care while we’re out of the state or country.

Fact: Global Urgent and Emergency Coverage

All our Generations Advantage plans – whether they are an HMO, HMO-POS, or LPPO plan—cover you for urgent and emergency care, anywhere in the world. Feel dizzy while sightseeing in Rome and need to see a doctor? Twist your ankle and need an urgent X-ray in Arizona or Mexico? No problem. We have your back.

First and foremost, although Martin’s Point Generations Advantage plans serve people whose primary legal residence is in Maine and New Hampshire, that doesn’t mean your medical care is only covered in these states! It’s an understandable misconception, but it’s simply not true. In fact, our plans have varying degrees of flexibility to see the provider of your choice for care that isn’t for an urgent or emergency need—and every single one of our plans covers urgent and emergency care, wherever you are.

So, that unexpected something you worry about happening away from home? With Martin’s Point Generations Advantage, you’re covered.

Myth: Part-Time Florida Resident's Concern

I live in Florida part of the year and need to have lab work done regularly, so I can't join Martin’s Point's most popular plan, the Generations Advantage Prime (HMO-POS) plan.

Fact: Comprehensive Lab Work Coverage With $0 Cost Share

Contrary to this common myth, the Generations Advantage Prime plan is perfectly suited for those who spend part of their year in Florida and require consistent lab work. This plan is tailored to provide comprehensive lab services coverage, ensuring your health monitoring continues seamlessly, regardless of your location. With Generations Advantage Prime, you benefit from:

  • Extensive Lab Work Coverage: Whether you're in Maine, New Hampshire, Florida, or elsewhere, the plan covers a wide array of necessary lab tests, including but not limited to glucose screenings, hepatitis screenings, lipid panels, and STI testing. These preventive lab services are available with no additional cost share, making your regular health check-ups hassle-free and economical.

  • Diagnostic Lab Work Affordability: For those times when diagnostic tests are required, the plan offers a straightforward and affordable approach. A nominal copay of just $5 applies for both in-network and out-of-network services, providing cost predictability and ease of access across state lines.

With Generations Advantage Prime, your healthcare follows you wherever you go, aligning with your lifestyle and ensuring continuous, high-quality care.

Myth: Cross-State Primary Care Preference

I live in New Hampshire, but I want to keep my primary care provider in Massachusetts, so I can’t join Martin’s Point Generations Advantage

Fact: Flexibility Across State Lines

With our LPPO-style plans you have the flexibility to see any provider or facility that accepts Medicare, anywhere in the United States—including that PCP in Massachusetts. Generation’s Advantage offers LPPO options with lower cost shares for in-network care and higher cost shares for out-of-network care. This allows us to manage costs and still give you maximum choice.

If value is your top priority, one of our HMO-POS plans might suit you best. Members in these plans enjoy wide in-network provider choice (at lower costs) with most benefits being offered with out-of-network coverage.

Finally, if you don’t need Part D Prescription Drug coverage, our HMO plan could be an excellent choice. Many military beneficiaries with access to prescription drugs through the Veterans Administration or TRICARE® choose this plan to enhance their benefits with generous extras like eyewear, hearing aids, wellness reimbursements, and over-the-counter benefits.

Finding it hard to choose? It’s important to ask yourself why you might want out-of-network care. This can help you pinpoint real-life needs and figure out which plan covers your them best. It’s also comforting to know that all of our plans cover emergency and urgent care in any situation.

We continuously update our range of Medicare Advantage plans to include a variety of options, ensuring that we meet the evolving health care needs of our members and providing high-quality options that balance value and choice.