Out-of-pocket maximums are located below by state/county.
*At pharmacies with preferred cost-sharing, you pay $0 for Cost-Sharing Tier 1 (preferred generic drugs and certain preferred brand name drugs). Other pharmacies are available in our network.
**Plan premium and prescription drug copayments don't count toward this maximum.
To obtain these supplemental dental benefits, you must use an in-network Delta Dental provider in Maine, New Hampshire, or Vermont. Find a Delta Dental network dentist.
Out-of-network: You may receive covered services at the out-of-network cost share from any dentist who accepts Medicare.
**Expenses incurred by the plan for covered dental services accrue to your annual maximum benefit.
Copays for in-network providers are as follows:
There is a $40 copay for 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.
Benefit includes up to $150 per year reimbursement for prescription lenses, frames, and contact lenses.
May be reimbursed using the Eyewear Reimbursement Request form.
Hearing benefits from Martin's Point are covered via Amplifon Hearing Health Care.
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.
These benefits are only available when purchasing a hearing aid through the Martin’s Point-Amplifon program.
Coverage includes:
*The 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.
MAINE: Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset and Washington counties
NEW HAMPSHIRE: Belknap, Carrol, Coos, and Grafton counties
MAINE: All other counties not listed above*
NEW HAMPSHIRE: All other counties not listed above*
*With your very first prescription, you begin in the Initial Coverage Phase and only pay a small copayment or coinsurance
SELECT | Formulary Search | Select Plan Comprehensive 2023 Formulary (PDF) |
*Costs shown above are for Phase 1 (Initial Coverage Phase).
**For Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, and Washington Counties in Maine; and Coos, Belknap, Carroll, and Grafton in New Hampshire, Tier 5 cost is 28%. For other Maine and New Hampshire Counties, Tier 5 cost is 33%.
IMPORTANT NOTE ABOUT PRESCRIPTION PRICING: In some cases, the cost of a drug is lower than the copay amount of its tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.
What you pay for your drugs depends on the drug tier, what “drug payment stage” you are in when you get the drug, and which pharmacy you use.
For members without a Part D deductible, you begin this phase when you fill your first prescription of the year and pay the cost shares noted above for covered drugs until your total yearly drug costs (what you pay PLUS what the plan pays) reach $4,660.
After your total yearly drug costs (what you pay PLUS what the plan pays) reach $4,660, you will pay 25% of the price for brand-name drugs (plus a portion of the dispensing fee) and pay 25% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $7,400.
After your yearly out-of-pocket drug costs (what you paid PLUS what drug manufacturers paid) reach $7,400, you pay:
*Different cost-sharing applies for members who receive "Extra Help" (Low-Income Subsidy (LIS/LICS))
Members receive $50 per quarter to purchase from over 350 CVS-brand, over-the-counter products. Note that unused quarterly amounts are forfeited (do not roll over into the next quarter).
A variety of products qualify, including those used for:
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.
Search and buy products online
Download the 2023 catalog (PDF)
Search OTC Benefit Pharmacy Locations
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.
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.
If your pharmacist has problems sending your claim to us, they should call our Part D Pharmacy Help Desk at 1-800-364-6331
Download the reimbursement form HERE
*Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Prime and costs do not count toward your Part D drug spend or out-of-pocket costs.
**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.
Talk to your doctor about which screening is right for you—all have a $0 copay when you go to an in-network provider. Ask 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.
The Select plan's Wellness Wallet benefit reimburses up to $300 annually for a wide range of eligible gear, fees, and services that help keep you moving, indoors and out!
Visit the Wellness Wallet Benefits page for more information on covered items and services.
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.
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:
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.
The Select plan includes a discount for medical alert devices through LifeStation. Please note, this is not a plan benefit and is instead a value-added discount.
This discount results in members receiving up to a ~25% discount off of regular consumer pricing, with discounted monthly costs ranging from $19.95 to $36.95, depending on the unit chosen.
LifeStation details:
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:
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.
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:
This service is provided by Carenet Healthcare Services in partnership with Martin's Point. This service is not intended to take the place of your primary care provider.
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.
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.
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