Member Resources for 2023

SUBMIT AN ONLINE PREMIUM PAYMENT (One-Time, Not Recurring)

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:

1. Member ID*
2. ARAC #
3. Member Name
4. Email 

NOTE: Please contact Member Services if you would like to set up recurring autopayment of your monthly premium payment.

Submit Payment

For any plan-specific documents, please see your individual 2023 plan page below.

Prime (HMO-POS) 

Alliance (HMO)

Value Plus (HMO)

Select (LPPO)

Focus DC (HMO SNP)

MARTIN'S POINT FORMULARY (List of Covered Prescription Drugs)

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.

PLAN NAME
Prime	Search Formulary	Prime Plan Comprehensive 2023 Formulary (PDF)
Select	Search Formulary	Select Plan Comprehensive 2023 Formulary (PDF)
Value Plus	Search Formulary	Value Plus Plan Comprehensive 2023 Formulary (PDF)
Focus DC	Search Formulary	Focus DC Plan Comprehensive 2023 Formulary (PDF)

PRIME PLAN

• For Prime, there are no deductibles to meet. With your very first prescription, you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use.

• Important Message About What You Pay for Vaccines – For plans with no deductible, our plan covers most Part D vaccines at no cost to you. For plans that have a deductible, our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.

• Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.
  
  

SELECT PLAN

• Select plan members in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, York, Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan counties, there are no deductibles to meet. With your very first prescription, you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use.

• Select plan members in Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington, Coos, Belknap, Carroll, and Grafton counties, you have a $275 deductible for drugs in Tiers 3, 4, and 5. There is no deductible for drugs in Tiers 1 and 2. Copayments/coinsurance are determined by what type of drug you are receiving as well as which pharmacy you choose to use.

• Important Message About What You Pay for Vaccines – For plans with no deductible, our plan covers most Part D vaccines at no cost to you. For plans that have a deductible, our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.

• Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.
  
  

VALUE PLUS PLAN

• Value Plus has a $275 deductible for Tiers 3, 4 and 5 medications. There is no deductible for Tiers 1 and 2 medications; you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use. For Tiers 3, 4 and 5, you pay the full cost of the drug until you reach your deductible.

• Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.

• Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.
  
  

FOCUS DC PLAN

• For Focus DC, there are no deductibles to meet. With your very first prescription, you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use. 

• Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you.

• Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.

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. 

• Medication Transition Process: Find out what to do if your medication isn’t in our formulary (covered drug list).

• Coverage Determination and Exceptions Process: There are several ways to request a coverage determination or an exception.

• Pharmacies and Out-of-Network Coverage: Learn more about the differences between in-network and out-of-network pharmacies.

• Request Part D Prior Authorization: Submit a request for a Medicare prescription drug coverage determination online. Submit request.

• Request for Redetermination of Medicare Prescription Drug Denial: If Martins Point Generations Advantage denies your request for coverage of (or payment for) a prescription drug, you have the right to ask for a redetermination (appeal) of the decision.  Submit appeal.

• Coverage Limits and Extra Help: Find out how prescription coverage limits impact you, and see if you qualify for assistance.

• Medication Therapy Management: Qualified members can participate in this voluntary program that can help you get the greatest benefit from your medications.

• Prescription Utilization Management: Some covered drugs may have additional requirements or limits on coverage.

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:

• Visit https://www.foodsmart.com/martinspoint to sign up.
• Send an email requesting an appointment to [email protected].
• Download the Foodsmart app in the App Store or Google Play. Click on “Sign Up.” Your Group is “Martin’s Point Generations Advantage.”

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:

• Smoking cessation: Nicotine replacement patches
• Oral health: Toothpaste, toothbrushes, floss
• Pain relief: Ibuprofen, acetaminophen
• Allergy: Allergy relief tablets
• Cold remedies: Cough drops, daytime/nighttime cold medicine
• Digestive health: Heartburn relief tablets, daily fiber
• First aid: Bandages
• Incontinence: Bladder control products

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.

Prime (HMO POS) Plan 

Value Plus (HMO) Plan

Select (LPPO) Plan

Alliance (HMO) Plan

Focus (HMO SNP) DC Plan

WHEN YOU PAY FOR THESE SERVICES IN-NETWORK:

• $0 copay for all plans: Annual routine eye exam (eye refraction) to determine the need for eyeglasses/contacts, once per calendar year.

• $0 copay for all plans: One glaucoma screening each year for people who are at high risk of glaucoma. (includes people with a family history of glaucoma, people with diabetes, African Americans who are age 50 and older and Hispanic Americans who are 65 or older)

• $0 copay for all plans: One diabetic eye exam (retinopathy screening) per year for people with diabetes.

• $40-45 copay depending on your plan: Medicare-covered, non-routine outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration.

 

EYEWEAR BENEFIT:

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.

MEDICARE-COVERED EYEWEAR AFTER CATARACT SURGERY:

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.

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)

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)

Summary of Benefits Focus DC (HMO-SNP) (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:

• A list of reimbursable items
• How to use your Wellness Wallet benefit
• Wellness Wallet FAQs  

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

WELLNESS WALLET REIMBURSEMENT REQUEST

This form is for any services covered under your 2022 Wellness Wallet reimbursement benefit. To be eligible for payment, the date of service or purchase must be in 2022 and you must submit your claim by March 31, 2023. 

2022 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. 

2023 Wellness Wallet Member Reimbursement (PDF)

EYEWEAR REIMBURSEMENT REQUEST

This form is for reimbursement for prescription eyewear up to your plan's maximum.

Member Reimbursement Request for Eye Wear (PDF)

MEDICAL SERVICES REIMBURSEMENT REQUEST

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)

MEDICARE PRESCRIPTION DRUG REIMBURSEMENT REQUEST

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. 

• 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.

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

Online: momsmeals.com/mpga
Phone: 1-877-347-3438

DISCOUNT OVERVIEW

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.

• Choose an in-home system (landline or cellular that can be used only in the home), LifeStation Smartwatch, or a mobile system with location services which can be used outside of the home

• Get discounted monthly costs ranging from $19.95– 36.95, depending on the unit 

• Fall-detection option available for an additional fee (automatically alerts LifeStation that you have fallen, even if you do not press the emergency button)

• Product warranty on all service plans (a $5 per month value at no charge)

• Spousal coverage available on all in-home units (a $3.99 per month value at no charge)

• Additional cost for a device protection plan may apply

When you need medical care quickly, it's good to know you have a wide range of quality options to choose from, depending on how severe your condition or injury may be. 

If you feel your condition is life-or-limb threatening, the emergency room is always the right choice. 

If not, we recommend your PCP or an urgent-care clinic—you could save time and money, while receiving excellent care from highly-trained medical professionals.

Find out more

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.

Automatic Payment Options Form (PDF)
Authorization to Release Information (PDF)
Medicare Appointment of Representative (PDF)
Members Rights and Responsibilities Statement (PDF)
Multi-language Interpreter Services (PDF)
Part D Senior Savings Model Eligible Insulin Drugs (PDF)
Preventive Care Checklist (PDF)
Provider Attestation for Supplemental Benefits Form (PDF)
Request for Medicare Prescription Drug Coverage Determination (PDF)
Request for Redetermination of Medicare Prescription Drug Denial (PDF)
Residence Address Verification Form (PDF)
Waiver of Liability (PDF)

 

All Generations Advantage plans cover many  important preventive services at $0 copays—including your Medicare Annual Wellness Visit and your Annual Physical Exam.

Ask your doctor to schedule both visits in one, longer “comprehensive visit” appointment and save a trip to the doctor while taking good care of your health.

Find a provider.

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 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:

• 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

Click HERE to learn more

Including The Advantage, our member newsletter

The Advantage Newsletter 2023 Issue 1 (02/16/23)

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)

 

Go to news and events

Medicare Terms and Resources

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.