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Member Resources for 2025

Helping you understand your health coverage and use your plan benefits.

Find information on using your benefits, after-hours and emergency care, prescription and pharmacies, reimbursements, and other forms to help you make the most of your health plan.


Your available plans based on your location in Maine & New Hampshire. Plan benefits and coverage vary by county.

2025 Generations Advantage Prime (HMO-POS) Plan
Our flagship comprehensive plan. Complete medical, hospital, and Part D Prescription Drug coverage with low copayments for in-network services. Point-of-Service (POS) benefit covers certain services from out-of-network providers. Includes valuable extra benefits. Available throughout Maine and New Hampshire.
View Plan
2025 Generations Advantage Select (LPPO) Plan
Offers widest choice of provider. Complete medical, hospital, and Part D Prescription Drug coverage. You can see out-of-network providers for all covered services, with the option to pay less if you see in-network providers. Includes valuable extra benefits. Available throughout Maine and some New Hampshire counties.
View Plan
2025 Generations Advantage Alliance (HMO) Plan
Offers comprehensive, in-network medical and hospital benefits at a $0 plan premium. Does not include Part D Prescription Drug coverage. Excellent choice if you already have prescription coverage through TRICARE®, the VA, or an employer plan. This plan offers rich extra benefits. Available in all counties in Maine and New Hampshire.
View Plan
2025 Generations Advantage Value Plus (HMO-POS) Plan
Complete medical, hospital, and Part D Prescription Drug coverage with $0 plan premium & low copayments for in-network services. Point-of-Service (POS) benefit covers certain services from out-of-network providers. Includes valuable extra benefits. Available in Maine only.
View Plan
2025 Generations Advantage Access (LPPO) Plan
Widest choice of provider with $0 plan premium. Complete medical, hospital, and Part D Prescription Drug coverage. You can see out-of-network providers for all covered services, with the option to pay less if you see in-network providers. Includes valuable extra benefits. Available in New Hampshire only. 
View Plan

Your Plan Documents

Find key documents and forms, including coverage details and reimbursement forms.

The Evidence of Coverage document provides the details of your Medicare health benefits, services, and prescription drug coverage as a member of Martin's Point Generations Advantage from January 1 – December 31, 2025. It explains how to get coverage for the health care services and prescription drugs you need.

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 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 Counties (PDF)

 

Value Plus (HMO-POS)

H5591-009 - All Maine Counties (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, Coos, and Grafton Counties in New Hampshire (PDF)

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

This is a summary of drug and health services covered under your Martin's Point Generations Advantage plan.

Summary of Benefits Prime (HMO-POS), Select (LPPO), Access (LPPO), Value Plus (HMO), and Alliance (HMO) (PDF)

  
Wellness Wallet Reimbursement Request

ONLINE REIMBURSEMENT REQUEST: Try this new option for easier submission and quicker processing!

Submit your Wellness Wallet reimbursement request online:

Submit Online Reimbursement Request



REQUEST BY MAIL: Use this form for items/services covered under your 2025 Wellness Wallet reimbursement benefit up to your plan’s annual limit. 

2025 Member Reimbursement Form Wellness Wallet/Eyewear (PDF)

To be eligible for payment, the date of service or purchase must be in 2025 and you must submit your claim by April 30, 2026. 

Learn more about this benefit on our Wellness Wallet Benefit page.



Eyewear Reimbursement Request

ONLINE REIMBURSEMENT REQUEST: Try this new option for easier submission and quicker processing!

Submit your Prescription Eyewear reimbursement request online:

Submit Online Reimbursement Request



REQUEST BY MAIL: Use this form for reimbursement for items eligible under your prescription eyewear benefit up to your plan's annual limit. (DO NOT use this form if your eyewear purchase is due to recent cataract surgery. In this case, use the Medical Services Reimbursement Form seen below.)

2025 Member Reimbursement Form Wellness Wallet/Eyewear (PDF)

To be eligible for payment, the date of service or purchase must be in 2025 and you must submit your claim by April 30, 2026.

Learn more about this benefit on our Vision Benefits page.



Medical Services Reimbursement Request

This form is for reimbursement for covered medical services that you received through a provider or at a medical facility. This also includes eyewear that you purchased due to recent cataract surgery.

Medical Services Reimbursement Form (PDF)

Learn more about this benefit on our Contact and Eyeglasses After Cataract Surgery page.



Prescription Drug Reimbursement Request

Use this form when you have paid out-of-pocket for your Part D formulary prescription drug. DO NOT use any other forms if your reimbursement request is for prescription drugs. 

Prescription Drug Reimbursement Form (PDF) 


Automatic Payment Options Form (PDF)
Use this form to sign up for automatic payment of your monthly plan premium.

Authorization to Release Information (PDF)
Use this form to authorize a designated representative to discuss certain aspects of your health care.

Continuity of Care Form (PDF)
Use this form to request a 90-day Continuity of Care period to ensure your ongoing care remains uninterrupted.

Medicare Appointment of Representative (PDF)
Use this form to appoint a representative who can assist with all Medicare-related inquiries.

Members Rights and Responsibilities Statement (PDF)
This document provides the Martin's Point Health Plan Member Rights and Responsibilities statement.

Multi-language Interpreter Services (PDF)
This document provides information for multi-language interpreter services.

Permission to Allow Martin's Point to Discuss My Health Care or Payment with My Designated Representative (PDF)
Control how your health information is shared by authorizing with this simple consent form.

Preventive Care Checklist (PDF)
Use this form to track your recommended preventive care and bring it with you to your next primary care visit.

Provider Attestation for Supplemental Benefits Form (PDF)
Use this form to receive supplemental benefits for specific diagnosis.

Request for Medicare Prescription Drug Coverage Determination (PDF)
Use this form to request coverage for a drug that isn’t covered or has restrictions.

Request for Redetermination of Medicare Prescription Drug Denial (PDF)
Use this form to request to appeal a denied prescription coverage.

Residence Address Verification Form (PDF)
Use this form to verify your residence address.

Waiver of Liability (PDF)
Use this form to waive any right to collect payment for services for which payment has been denied.

Veterans Affairs Record Release form (PDF) 
Use this form to authorize the Department of Veterans Affairs to release specific health information to designated individuals or organizations.

 

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Benefits and Programs

Explore added benefits and programs for screenings, therapy drugs, personalized care management, and more.
Get your health care journey off to a great start.

Take your Health Risk Assessment—an online questionnaire to help you understand your health/health risks, and guide you toward being as healthy as possible.


How to Take Your Health Risk Assessment (HRA)

To take the HRA (at no additional charge) you must first have an online portal account. Log in with your portal username and password or click “Register” if this is your first time logging in. When prompted, enter your Generations Advantage member ID number and follow the instructions.

This website will allow only you to see your results anytime.

You can find the Health Risk Assessment here: 

Health Risk Assessment

If you don’t have internet access or have questions, call us at 1-877-659-2403 (TTY: 711) and leave a message. We will return your call within two business days.

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.

For detailed information, visit Flu Vaccine page
Martin's Point Generations Advantage Comprehensive Dental Benefit

COVERAGE INFORMATION & PROVIDER NETWORK

  • Coverage: Enjoy enhanced preventive care with up to two cleanings per calendar year for all members with dental coverage, except Cumberland and York County Prime plan members, who are eligible for one cleaning. 
  • Member Cost: There is no waiting period or deductible. Benefit maximums, office visit copays, and costs for restorative services vary by plan. See the chart below or review your Evidence of Coverage for plan specific details.
  • Provider Network: The Dental Benefit is administered by Northeast Delta Dental (NEDD).  To obtain these supplemental dental benefits at the in-network rates, you must use a Delta Dental network provider in Maine, New Hampshire, or Vermont. 
Network Provider Search Tool

BENEFIT DETAILS BY PLAN 

Amounts under categories A, B, and C show what the MEMBER pays:

Dental Benefits by Area Calendar Year Maximum Paid by Plan**  A  Diagnostic / Preventive  B  Basic Restorative  C  Major Restorative
Prime (HMO-POS)

Plan ID: H5591-015-001

ME Counties: Lincoln, Oxford, Piscataquis, Somerset, Waldo
NH Counties: Belknap, Carroll, Coos, and Grafton

All services must be received in network.

 $500  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
Prime (HMO-POS)

Plan IDs: H5591-015-002 | H5591-006-001

ME Counties: Aroostook, Cumberland, Franklin, Hancock, Knox, Penobscot, Washington, York

All services must be received in network.

 $750  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
Prime (HMO-POS)

Plan ID: H5591-006-002

ME Counties: Androscoggin, Kennebec, and Sagadahoc

All services must be received in network.

 $1,500  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
Prime (HMO-POS)

Plan ID:  H5591-005

NH Counties: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

All services must be received in network.

 $1,250  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
Alliance (HMO)

Plan ID: H5591-003

All Maine and New Hampshire Counties

All services must be received in network.

 $2,500  $0 Office Visit Copay  20% Coinsurance  50% Coinsurance
Value Plus (HMO-POS)

Plan IDs: H5591-009 |
H5591-013

ME Counties: Aroostook, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, and Washington

All services must be received in network.

  $2,000  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
Select (LPPO)

Plan ID: H1365-001

ME Counties: All Counties
NH Counties: Cheshire, Coos, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

For a higher cost share, Select (LPPO) plan members may also see dentists who accept Medicare in the complete Northeast Delta Dental network.

  $1,500  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
Access (LPPO)

Plan ID: H1365-002

NH Counties: Belknap, Carroll, Coos, and Grafton

For a higher cost share, Access (LPPO) plan members may also see dentists who accept Medicare in the complete Northeast Delta Dental network.

  $1,000  $50 Office Visit Copay $50 Office Visit Copay and 50% Coinsurance $50 Office Visit Copay and 50% Coinsurance
Access (LPPO)

Plan ID: H1365-003

NH Counties: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

For a higher cost share, Access (LPPO) plan members may also see dentists who accept Medicare in the complete Northeast Delta Dental network.

  $2,000  $50 Office Visit Copay  $50 Office Visit Copay and 50% Coinsurance  $50 Office Visit Copay and 50% Coinsurance
For detailed information, visit the Dental benefit page
Medicare-Covered Original Medicare Vision Benefits

NON-ROUTINE EYE EXAM

  • Service Coverage: Covers non-routine outpatient physician services for eye diseases and injuries, including age-related macular degeneration.

  • Member Cost: $0-45 copay depending on your plan. See your Evidence of Coverage for plan specific details.

Medicare-Covered Contacts & Eyeglasses After Cataract Surgery

POST CATARACT EYEWEAR

  • Coverage: Members pay 20% coinsurance of the Medicare-allowable rate for standard eyeglasses or contacts post-cataract surgery with intraocular lens insertion.

  • Reimbursement: To submit for reimbursement, use the Medical Services Reimbursement Form (PDF). Note: Reimbursement paperwork, including proof of payment, must be received within a year of the date of service.
For detailed information, visit the Contact and Eyeglasses After Cataract Surgery page

Martin's Point Generations Advantage Vision Exam and Supplemental Eyewear Benefit

ANNUAL ROUTINE EYE EXAM

  • Coverage: This benefit includes a comprehensive eye exam to assess your need for eyeglasses or contacts, and may also cover diabetic eye exams and glaucoma screenings for high-risk individuals.

  • Frequency: Covered once per calendar year. This means you can have an exam once at any point in a year, from January through December. For example, if you have an exam in December, you're eligible for another exam as early as January the following year.

  • Member Cost: $0 copay. See your Evidence of Coverage for plan specific details.
   Note: This benefit covers the eye exam only and does not include eyewear.

EYEWEAR ALLOWANCE AND REIMBURSEMENT

  • Benefit Description: This benefit provides an annual eyewear allowance, which members can claim through our reimbursement process. Your plan reimburses up to an annual amount for prescription lenses, frames, and contact lenses for the purpose of correcting/improving a member’s vision. Amount varies by plan (See below).

  • ONLINE REIMBURSEMENT REQUEST: Try this new online reimbursement option for easier submission and quicker processing!

    Submit Online Now

  • REQUEST BY MAIL: Use this new form for reimbursement for items eligible under your prescription eyewear benefit up to your plan's annual limit. (DO NOT use this form if your eyewear purchase is due to recent cataract surgery. In this case, use the Medical Services Reimbursement Form (PDF).)

2025 Member Reimbursement Form (PDF)

To be eligible for payment, the date of service or purchase must be in 2025 and you must submit your claim by April 30, 2026.

Annual Reimbursement Maximum: The reimbursement limit for eyewear varies based on your plan:

Prime
Value Plus
Select
Alliance
Access

$100* | $150**

 $100  $150  $200 $150
 

*For Prime plan: $100 reimbursement in Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties; ** All other counties

For detailed information, visit the Vision benefit page
Our Prime, Select, Value Plus, and Access plans include comprehensive Part D Prescription Drug coverage. See below for specific information about drug costs, copays, and drug tiers for your plan, each with its own unique formulary and terms.

Plan-Specific Formularies:

In addition to providing a comprehensive formulary, Martin’s Point Generations Advantage offers a straightforward prescription drug reimbursement process for out-of-pocket expenses. This ensures that you are supported financially while receiving the necessary medical treatments:

Please use the Prescription Drug Reimbursement Form (PDF).

 

Comprehensive Coverage and Formulary Details:

Our Part D plans follow Medicare's drug coverage phases—Deductible, Initial, and Catastrophic—and detailed formulary details, including tiers, copays, and deductibles. For a complete guide to your plan's coverage and costs, see our detailed coverage and formulary breakdown.

Affordable Insulin and Vaccine Costs:

All plans cap insulin costs and provide vaccine coverage, ensuring affordability for our diabetic members and promoting preventive health. For detailed information on these savings, visit our insulin and vaccine savings section.

Pharmacy Access:

Filling your prescription is easy. Explore our Network Pharmacy Page for details on mail-order options and preferred network pharmacies.


Dive Deeper into Your Prescription Drug Coverage

For comprehensive insights into coverage determination, medication management, and to learn about available assistance programs for prescription drug costs, visit our Pharmacy and Prescription Resources Page.

For detailed information, visit the Drug Formulary Page
Preferred Pharmacies & Mail Order Service

EXPERIENCE CONVENIENCE & SAVINGS WITH OUR PHARMACY OPTIONS

Choose your preferred pharmacy:

  • Hannaford & CVS Pharmacies: Benefit from lower copays at these national chains.

  • Generations Advantage Members Enjoy More: Find medications at reduced costs across all tiers of our formulary.

Find Your Preferred Pharmacy


EFFICIENT MAIL-ORDER SERVICE BY CVS CAREMARK

  • Manage Prescriptions with Ease: Ideal for long-term medication needs, order up to a 90-day supply.

  • Efficient and Dependable Service: Orders are processed and delivered within 10-14 days. To ensure smooth delivery, especially in case of occasional delays, we suggest placing your orders up to 3 weeks in advance.

  • Automatic Refill Program: Opt for ReadyFill at Mail® and never worry about running out of medications.

  • Dedicated 24/7 Customer Support: Reach out to CVS Caremark at 1-888-296-6961 for any assistance with your mail-order prescriptions.

Start Your Mail-Order

For detailed information, visit the Pharmacy and Prescription Resources Page
Stay connected and secure with LifeStation

At Martin's Point, we’ve partnered with LifeStation to offer peace of mind and security through advanced medical alert devices. Whether you’re eligible for our Covered Medical Benefit (Alliance plan members only) or looking to take advantage of our value-added discount (available to all other plan members), LifeStation ensures you're always connected when it matters most.

COVERED MEDICAL BENEFIT (ALLIANCE (HMO) MEMBERS ONLY)

For Martin's Point Generations Advantage Alliance plan members, this benefit offers fully covered medical alert devices. You'll receive 24/7 monitoring with no out-of-pocket costs for shipping, activation, or monthly fees (valued at $13.95–$18.95 per month). Covered devices include:

  • In-home landline system
  • In-home cellular system
  • In-home cellular system with fall detection
  • Mobile unit with GPS/Wi-Fi
  • Mobile unit with GPS/Wi-Fi and fall detection

Spousal coverage and product warranties are also included at no additional charge.

How to Use Your Covered Medical Benefit:

  1. Dedicated web page: LifeStation Medical Alert - Martin's Point
  2. Call to enroll: 1-866-220-0934
    Speak directly with a LifeStation representative to enroll—be sure to have your Generations Advantage Member ID ready.

What’s Covered:

  • Shipping and activation fees
  • Monthly device and monitoring fees
  • Spousal coverage for in-home devices
  • Product warranties
  • Note: Optional accessories, including a smartwatch, are not included.

 

GENERATIONS ADVANTAGE DISCOUNT ON MEDICAL ALERT DEVICES

Generations Advantage plan members (Access, Select, Prime, and Value Plus) receive 25% discounts on medical alert devices through LifeStation. Please note, this is a value-added discount, not a covered plan benefit.

How to Use Your Value-Added Discount:

  1. Dedicated web page: LifeStation Medical Alert - Martin's Point
  2. Call to enroll: 1-855-793-8555
    Speak directly with a LifeStation representative to enroll—no Generations Advantage ID required. 
  3. Payment information needed: Provide a credit card or bank account for automatic deductions of monthly charges for the device and monitoring.

What’s Covered:

  • Shipping and activation fees
  • Monthly charges for device and monitoring
  • Note: Optional accessories, including a smartwatch, can be offered at additional rates.

Devices & Pricing:

  • In-home landline: $19.95/month
  • In-home cellular: $25.95/month
  • Mobile unit with GPS/WiFi: $29.95/month
  • Fall detection (optional add-on): $5.00/month
     

 

MANAGING YOUR LIFESTATION SERVICE

Once enrolled in either option, LifeStation makes it easy to manage your service and get support when you need it:

  • Customer Service Number: 1-800-998-2400 for troubleshooting or to explore device add-ons.

 

The Part B Step Therapy requirement encourages members to try less costly but usually just as effective ‘preferred’ drugs before the plan covers another ‘preferred’ drug. For example, if Drug A (preferred) and Drug B (non-preferred) treat the same medical condition, the plan may require you to try Drug A first. If Drug A does not work for the member, the plan will then cover Drug B.

Step therapy is not required for members who have used a non-preferred drug within the last 365 days, but authorization is required. To see list of preferred and non-preferred step therapy drugs please see our 2025 Part B Step Therapy Drug List (PDF).

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.

Screening Test
How Often
Mode of Screening

Fecal Occult Blood Test (gFOBT, iFOBT)

Fecal Immunochemical Test (FIT)

 Every calendar year (between the ages of 45-75 years) At home
DNA-based Test: Cologuard® Every three years At home

Flexible Sigmoidoscopy

OR

Screening Barium Enema

 Every five years At facility
Colonoscopy Screening Every 10 years At facility
For detailed information, visit the Evidence of Coverage page

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.

For detailed coverage information, visit Care Management Programs

Eligible members have the option to purchase nutritionally balanced, refrigerated, and ready-to-eat meals that are delivered by Mom’s Meals directly to your home.

  • Martin’s Point Generations Advantage members will get free shipping on all orders (a savings of $14.95).
  • Menus are designed by chefs and registered dietitians to support general wellness goals or the specific nutrition needs of common health conditions.
  • Members can select every meal, every order from over 70 entrée options.
  • Entrées are refrigerated and ready-to-eat after just two minutes in the microwave.

Eligibilitly: This is available for plan members with congestive heart failure (CHF) or end-stage renal disease (ESRD) post-discharge or post-surgery, or for members with CHF or ESRD who indicate need and meet objective screening criteria.

Benefit Details:

  • Up to 7 days (14 meals) of coverage for each qualifying event (post-discharge, post-surgery, or need identified by the plan).
  • Up to an additional 7 days (14 meals) of coverage when extended need and high risk is identified by the plan.

Alliance (HMO) Plan Members: In addition, Alliance members have a separate meal benefit:

  • Up to 3 weeks (42 meals) per inpatient stay or surgery.
  • Up to 1 week (14 meals) per year for members with chronic conditions (such as diabetes mellitus (DM) or chronic obstructive pulmonary disease (COPD)) as part of a supervised program to transition into lifestyle modifications.

Place your order online or by phone using code MPGA to activate the offer:

Online: MomsMeals.com/MPGA
Phone: 1-877-347-3438

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Additional Services and Support

Find The Advantage Newsletter, state resources, 24/7 nurse support, and more.
The Advantage, our Member Newsletter

Stay Informed with the Latest Generations Advantage News and Updates

 

The Advantage Newsletter 2024 Issue 3 (11/18/24)

The Advantage Newsletter 2024 Issue 2 (6/27/24)

The Advantage Newsletter 2024 Issue 1 (3/5/24)

The Advantage Newsletter 2023 Issue 3 (11/24/23)

The Advantage Newsletter 2023 Issue 2 (7/5/23)

The Advantage Newsletter 2023 Issue 1 (2/16/23)

The Advantage Newsletter 2022 Issue 4 (11/9/22)

The Advantage Newsletter 2022 Issue 3 (PDF) (8/23/22)

The Advantage Newsletter 2022 Issue 2 (PDF) (5/24/22)

 

Go to news and events

Medicare Terms and Resources

Empower Your Health Care Decisions

Gain insight into how we determine the medical necessity for treatments and services, ensuring you receive care that meets established medical standards. This knowledge supports your health care journey with us, aligning with Medicare's guidelines. Visit the Clinical Coverage Criteria page for more information.

What is the Maximum Out-of-Pocket limit

Your Maximum Out-of-Pocket limit is the most you will pay for covered medical services in a fiscal year. Once you reach your Maximum Out-of-Pocket limit, you will no longer pay cost shares for those services. Here’s what you need to know:


How do I know if I’ve reached my Maximum Out-of-Pocket limit?

To check if you’ve hit your limit, contact Member Services at 1-866-544-7504. They can confirm your status and provide a Maximum Out-of-Pocket letter upon request, which can be shown at your doctor's office to confirm that you no longer need to pay cost shares.


What counts toward my Maximum Out-of-Pocket limit?
  • Medical Service Copays
  • Medical Service Coinsurance
  • Durable Medical Equipment (DME) Cost Shares

What does not count toward my Maximum Out-of-Pocket limit?
  • Dental Service Cost Shares
  • Hearing Aid Cost Shares
  • Wellness Wallet & Eyewear Allowance
  • Plan Premium
  • Part D Prescription Drug Cost Shares

How can I request my Maximum Out-of-Pocket letter?

If you’ve met your Maximum Out-of-Pocket limit, call Member Services at 1-866-544-7504 to request your letter. If you haven’t met the limit, a letter will not be generated.

Discover More on Our Trusted Third Party Vendor Page!

Our page connects you directly with trusted partners, making it easier than ever to manage your benefits. From exclusive discounts to personalized support, our vendors are here to help you get the most out of your membership. Direct access to the services and solutions you need. Explore what’s available and take control of your health and wellness today!

For detailed information, visit Explore Our Trusted Third Party Vendors
Social Security
1-800-772-1213
(TTY/TDD: 1-800-325-0778)

Medicare
1-800-MEDICARE (1-800-633-4227)
(TTY/TDD: 1-877-486-2048)
24 hours a day, 7 days a week

Maine State Health Insurance Assistance Program
1-800-262-2232
(TTY/TDD: 1-800-606-0215)

Maine Low Cost Drugs for the Elderly or Disabled Program (DEL) and Maine Rx Plus
1-866-796-2463
(TTY/TDD: 1-800-423-4331)

MaineCare (Medicaid)
207-287-2674
(TTY/TDD: 711)

New Hampshire Medicaid
1-800-852-3345 ext 4344 or
603-271-4344

New Hampshire ServiceLink Resource Center Network
1-866-634-9412

New Hampshire Medication Bridge Program
603-225-0900
 

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), 8am–8pm, seven days a week from October 1–March 31, and Monday through Friday the rest of the year, to discuss your concerns.

For detailed information, visit Member Grievances and Appeals
24-Hour Nurse Lines

No charge for Generations Advantage members.

When you're unsure about the severity of your medical issue, our 24-Hour Nurse Line is an indispensable tool that's available to you at no additional cost. It's the perfect resource for those times when you need advice on non-life-threatening conditions or injuries after regular clinic hours.

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 to speak with a registered nurse.

Use the Nurse Line if you need to know:

  • If a cut requires stitches
  • If you should go to urgent care, the ER, or wait to see your doctor
  • General information about a condition, medication, or other health concerns

This service is provided by Carenet Healthcare Services in partnership with Martin's Point. It is not intended to take the place of your primary care provider.

When to Go to the Emergency Room (ER)

ERs are the best choice when conditions are life-or-limb-threatening and may require advanced treatment.

Hospital ERs are open 24 hours every day and offer access to specialists. The average ER wait time for non-emergencies is 90–120 minutes.

Go to your nearest ER if you have:

  • Chest pain
  • Unusual shortness of breath
  • Severe abdominal pain
  • Uncontrolled bleeding
  • Signs of stroke like sudden weakness, difficulty speaking, or severe headache

Important Information for Members Traveling Abroad

When traveling outside the United States, it's crucial to understand how your health care coverage works and the requirements of your destination country.

Generations Advantage plans reimburse for urgent and emergency care services received out of the country, applying the in-network copays and coinsurance specific to your plan. However, please note that coverage does not guarantee your eligibility to receive care or medications in countries other than the US. Eligibility for medical services and medications is determined by each country and can vary widely.

We strongly recommend that members traveling abroad seek information regarding health care policies and procedures from each destination country prior to departure. This can help you avoid any issues and ensure you are prepared in case of a medical emergency.

For further assistance, please contact our Member Services team before your trip.

Better Access to Your Health Information

As part of the 21st Century Cures Act regulations, the Centers for Medicare and Medicaid (CMS) policy now requires that systems be put in place to make it easier for you to see your important health data. Under the systems, you’ll be able to:

  • Easily access your health claims information, including treatment and prescription history and costs
  • Find an up-to-date list of in-network providers
  • Know which providers have agreed to provide electronic access to your health information
For detailed information, visit the 21st Century Cures page

Have questions? We're here to help.

From October 1 to Mar. 31, we’re here 7 days a week, & Monday to Friday the rest of the year from 8am–8pm. 

 1-866-544-7504

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