Information and resources for Generations Advantage members.
Find additional 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. Review Member Resources for 2024 here.
You can submit a one-time (not recurring) online premium payment through PayTrace by clicking the button below. (Note: This will open in a new window.)
Please have a copy of your most recent statement handy before submitting your one-time online payment. You will need the following information (in addition to your payment method) to submit a one-time online payment:
NOTE: Please contact Member Services if you would like to set up recurring autopayment of your monthly premium payment.
Martin’s Point Generations Advantage uses a formulary. A formulary is a list of covered drugs selected by Martin’s Point Generations Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Martin’s Point Generations Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Martin’s Point Generations Advantage network pharmacy, and other plan rules are followed. For your coverage, click your plan page formulary below.
Visit our prescription and pharmacy page for more details. Prescription and Pharmacy benefits are available for Plan Year 2024 to review.
PLAN NAME | ||
---|---|---|
Prime | Search Formulary |
Prime Plan 2023 Formulary (PDF) |
Select | Search Formulary | Select Plan 2023 Formulary (PDF) |
Value Plus | Search Formulary |
Value Plus Plan 2023 Formulary (PDF) |
Focus DC | Search Formulary |
Focus DC Plan 2023 Formulary (PDF) |
Our formulary is reviewed and updated regularly by medical and pharmacy professionals. A formulary may change during the year if we: remove drugs from our formulary, add prior authorization, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier. Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during that same coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released.
We must notify you if a drug you are taking is changing at least 30 days before the change becomes effective. At the time you request a refill, you will receive a 30-day supply of the drug. Martin’s Point Generations Advantage covers both brand-name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.
This 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 Part B Step Therapy Drug List (PDF).
Martin’s Point Health Care has teamed up with Foodsmart™ to provide you with free, unlimited chats with a nutrition coach—plus much more—to support healthy eating from the comfort of home.
You don’t need to use your health plan’s Wellness Wallet reimbursement program to take advantage of this benefit as your Generations Advantage plan covers 100% of the program cost.
The Foodsmart program is tailored to your individual needs and preferences—from nutrition tips for managing a medical condition, to simply wanting to eat healthier, or just trying to save on groceries.
Your Foodsmart nutrition coach and other resources can make healthy eating easier and more affordable.
To get started, call 1-888-837-5325 to schedule an appointment with a nutrition coach. If you are having online difficulties signing up, call 1-888-837-5325 for technical support.
If you prefer to reach out online, you can:
The Martin’s Point Generations Advantage Dental Benefit is administered by Northeast Delta Dental (NEDD). Visit our Dental Benefit page to learn more.
To learn if your plan includes dental coverage, you may call Member Services at 1-866-544-7504 (TTY: 711). For details about your dental benefit, call the Northeast Delta Dental Customer Service Department at 1-800-832-5700 (TTY: 1-800-332-5905) Monday through Friday, 8 am–4:45 pm.
To find out if your dentist participates in the NEDD Martin’s Point Generations Advantage dental network, please use the Delta Dental Dentist Search tool or contact NEDD directly.
All Generations Advantage plans have OTC benefits with Over the Counter Health Solutions (OTCHS) by CVS Caremark.
Members receive a quarterly amount to purchase from over 350 CVS-brand, over-the-counter products, including these and more:
You may make a purchase in person at participating CVS locations, over the phone by calling OTC Health Solutions at 1-888-628-2770 (TTY: 711), or online. Visit our OTC benefits page to learn more.
Search and buy products online
Download the 2023 catalog (PDF)
Search OTC Benefit Pharmacy Locations
Amplifon will help you find a hearing aid provider near you, explain the process, help you schedule an appointment, and send information to you and the provider, ensuring your discount is applied. Call Amplifon, 8 am–8 pm, Monday through Friday to get started: 1-888-669-2167 (TTY: 711)
Learn more about your hearing aid benefit information. Click on your health plan link to learn more or visit our hearing aid benefit page.
Your eyewear benefit reimburses for lenses, frames, and contact lenses up to your plan’s annual amount. Please visit our Vision Services page for more details.
Eyewear Reimbursement Form (PDF)
Note: Within a year of the date of service, reimbursement paperwork must be received. When submitting, kindly include the itemized proof of payment.
For all plans: 20% of Medicare-allowable rate for standard eyeglasses (standard frames/standard lenses) or contacts after cataract surgery that includes insertion of intraocular lens.
This form is for reimbursement for standard eyeglasses (standard frames/standard lenses) or contacts after cataract surgery.
Member Reimbursement Request for Medical Services (PDF)
Note: Within a year of the date of service, reimbursement paperwork must be received. When submitting, kindly include the itemized proof of payment.
The evidence of coverage document outlines your Medicare health benefits, services, and prescription drug coverage as a member of Martin's Point Generations Advantage.
This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2023. It explains how to get coverage for the health care services and prescription drugs you need.
Evidence of Coverage documents for all of our plans can be found below.
For all counties in Maine and New Hampshire (PDF)
For Belknap, Carroll, and Grafton Counties in New Hampshire (PDF)
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)
This is a summary of drug and health services covered by Martin's Point Generations Advantage.
Summary of Benefits Prime (HMO-POS), Select (LPPO), Value Plus (HMO), and Alliance (HMO) (PDF)
Your flexible Wellness Wallet benefit reimburses up to your plan’s annual amount for a wide range of eligible gear, fees, and services that help keep you active and well.
On our Wellness Wallet Information page you can find:
2023 Wellness Wallet Member Reimbursement (PDF)
This form is for any services covered under your 2023 Wellness Wallet reimbursement benefit. To be eligible for payment, the date of service or purchase must be in 2023 and you must submit your claim by March 31, 2024.
If you are not sure whether your expense is eligible for reimbursement, please call Martin's Point Generations Advantage Member Services at 1-866-544-7504 or see the Wellness Wallet FAQs for details
This form is for any services covered under your 2023 Wellness Wallet reimbursement benefit. To be eligible for payment, the date of service or purchase must be in 2023 and you must submit your claim by March 31, 2024.
2023 Wellness Wallet Member Reimbursement (PDF)
This form is for reimbursement for prescription eyewear up to your plan's maximum.
Member Reimbursement Request for Eye Wear (PDF)
This form is for reimbursement for medical services that you received through a provider or at a medical facility.
Member Reimbursement Request for Medical Services (PDF)
This form is the prescription drug reimbursement form. It is used when you have paid out-of-pocket for your formulary prescription drug.
Reimbursement Request for Medicare Prescription Drug Purchase (PDF)
Members have the option to purchase nutritionally balanced, refrigerated, and ready-to-eat meals that are delivered by Mom’s Meals direct to your home.
Place your order online or by phone using code MPGA to activate the offer:
Online: momsmeals.com/mpga
Phone: 1-877-347-3438
Generations Advantage plans includes a discount for medical alert devices through LifeStation. Please note, this is not a plan benefit and is instead a value-added discount.
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.
For more information on this process, please visit our Grievances & Appeals page.
As part of the 21st Century Cures Act regulations, the Centers for Medicare and Medicaid (CMS) policy now requires that new systems be put in place next year to make it easier for you to see your important health data. Under the new systems, you’ll be able to:
Click HERE to learn more
Including The Advantage, our member newsletter
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 (8/23/22)
The Advantage Newsletter 2022 Issue 2 (5/24/22)
The Advantage Newsletter 2022 Issue 1 (2/18/22)
The Advantage Newsletter 2021 Issue 4 (11/5/21)
The Advantage Newsletter 2021 Issue 3 (8/19/21)
The Advantage Newsletter 2021 Issue 2 (5/18/21)
The Advantage Newsletter 2021 Issue 1 (02/23/21)
COVID-19 vaccines are covered for Medicare Advantage plan members with no out-of-pocket costs. Make sure to bring your red, white, and blue Medicare card when you receive the vaccine or booster.
For additional coverage information, please see our COVID-19 Resources for Generation Advantage Members.
1Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Alliance and costs do not count toward your Part D drug spend or out-of-pocket costs.
2To qualify for reimbursement, services must be provided by practitioners who are practicing in the state in which they are licensed or certified, and are furnishing services within the scope of practice as defined by their licensing or certifying state (i.e., physician, nurse, registered dietitian, or nutritionist).
3The copays listed are for hearing aids offered through the Martin’s Point-Amplifon Five-Tier program. Your provider will recommend a hearing aid on these tier levels based on your lifestyle and hearing loss.
4Ask your primary care provider what schedule is right for you. We cover these screenings more frequently for people at high risk for colorectal cancer. See your Evidence of Coverage for more information.
5The copays listed are for hearing aids offered through the Martin’s Point-Amplifon Five-Tier program. Your provider will recommend a hearing aid on these tier levels based on your lifestyle and hearing loss.
You may download Adobe Reader free to view the PDF documents.
The materials on this page may be made available in other formats such as Braille, large print or other alternate formats. Please contact us for more information. Call Member Services 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. Calls to this number are free.