Member Resources for 2024
Helping you manage your health coverage and plan benefits.
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. For members looking ahead, you can find Member Resources 2025 here.
Benefit Details Overview
Discover the full range of your health benefits, from dental to vision and prescriptions.
The Martin’s Point Generations Advantage dental benefit is administered by Northeast Delta Dental (NEDD).
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.
Please note that, for most plans, there is up to a $50 copay for each office visit. Plan members also pay any additional cost shares. To learn more about specific dental coverage, visit our dental benefit page. Note: Coverage varies by plan.
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.
The Generations Advantage extra hearing benefit covers hearing aids/batteries and is administered through our partner, Amplifon. Members who purchase hearing aid(s) through Amplifon receive an annual allowance to use toward the purchase. 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 allowance amount is applied. Call Amplifon, 8 am–8 pm, Monday through Friday to get started: 1-855-533-7486 (TTY: 711)
Learn more about your hearing aid benefit information. Note: Allowance amounts vary by plan.
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.
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: $0-45 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.
Martin's Point Generations Advantage Covered Supplemental Eyewear Benefit
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).
- NEW for 2024! ONLINE REIMBURSEMENT REQUEST: Try this new online reimbursement option for easier submission and quicker processing!
- 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.)
2024 Member Reimbursement Form
To be eligible for payment, the date of service or purchase must be in 2024 and you must submit your claim by April 30, 2025.
Annual Reimbursement Maximum: The reimbursement limit for eyewear varies based on your plan:
*For Access plan: $150 reimbursement in Belknap, Carroll, Coos, and Grafton Counties; $250 reimbursement in Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties.
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 2024 Part B Step Therapy Drug List (PDF) and 2025 Part B Step Therapy Drug List (PDF).
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. Quarterly amounts do not roll over to the next quarter. Available items include 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
Download the 2024 catalog (PDF)
*Quarterly amounts varies by county. Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan counties in New Hampshire $25/quarterly, all others $50/quarter.
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 search and buy products online.
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.
To be eligible for payment, the date of service or purchase must be while you were enrolled in a 2024 Generations Advantage plan and you must submit your claim by March 31, 2025. To see a list of items/services eligible for reimbursement, visit the Wellness Wallet benefit page. 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 (TTY: 711) or see the Wellness Wallet FAQs for details.
NEW for 2024! ONLINE REIMBURSEMENT REQUEST: Try this new online reimbursement option for easier submission and quicker processing!
REIMBURSABLE AMOUNTS BY PLAN
Your Wellness Wallet reimburses up to your plan’s annual amount for covered items/services. Reimbursement amounts by plan are as follows:
Overview
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.
Documents and Forms
Access key documents and forms, including coverage details and reimbursement forms.
For any plan-specific documents, please see your individual 2024 plan page below.
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, 2024. It explains how to get coverage for the health care services and prescription drugs you need.
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 - For 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, Coos, and Grafton counties Counties in New Hampshire (PDF)
This is a summary of drug and health services covered under your Martin's Point Generations Advantage plan.
NEW for 2024: We’ve created a new, combined form—“2024 Member Reimbursement Form—Wellness Wallet/Eyewear.” This form should be used when submitting a request by mail for reimbursement for items under your 2024 Wellness Wallet benefit and items under your separate prescription eyewear benefit (not related to cataract surgery). See details below!
Wellness Wallet Reimbursement Request
NEW FOR 2024! ONLINE REIMBURSEMENT REQUEST: Try this new option for easier submission and quicker processing!
Submit your Wellness Wallet reimbursement request online:
REQUEST BY MAIL: Use this form for items/services covered under your 2024 Wellness Wallet reimbursement benefit up to your plan’s annual limit.
2024 Member Reimbursement Form Wellness Wallet/Eyewear
To be eligible for payment, the date of service or purchase must be in 2024 and you must submit your claim by April 30, 2025.
Learn more about this benefit on our Wellness Wallet Benefit page.
Eyewear Reimbursement Request
NEW FOR 2024! ONLINE REIMBURSEMENT REQUEST: Try this new option for easier submission and quicker processing!
Submit your Prescription Eyewear reimbursement request online:
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.)
2024 Member Reimbursement Form Wellness Wallet/Eyewear
To be eligible for payment, the date of service or purchase must be in 2024 and you must submit your claim by April 30, 2025.
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.
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.
Health and Wellness Programs
Explore programs for nutrition, emergency response, and personalized care management
Overview
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 by telephone or online.
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 prefer to reach out online, you can:
- Visit https://www.foodsmart.com/martinspoint to sign up. If you are having difficulties signing up online, call 1-888-837-5325 for technical support
- 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.”
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.
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:
- Dedicated web page: LifeStation Medical Alert - Martin's Point
- 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:
- Dedicated web page: LifeStation Medical Alert - Martin's Point
- Call to enroll: 1-855-793-8555
Speak directly with a LifeStation representative to enroll—no Generations Advantage ID required. - 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.
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
Overview
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.
Comprehensive Services, Support, and Insights
Find payment options to state resources, 24/7 nurse support, and deepen your understanding with 'The Advantage' newsletter and our Medical Care Criteria Overview.
Pay your Generations Advantage plan premium online.
One-Time Payment
It's easy to make a one-time credit card payment. Click the button below to use the PayTrace service to make your secure payment.
Recurring Monthly Payments
To set up secure, recurring payments, please call Member Services or complete/mail an Automatic Payment Form.
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)
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.
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), 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.
Overview
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 if you need to know:
- If a cut requires stitches
- If you should head to an urgent care clinic, the ER, or wait until morning to see your doctor
- General information about a condition, medication, or other health concerns
This service is provided by Carenet Health in partnership with Martin's Point. This service is not intended to take the place of your primary care provider.
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.