2023 Select (LPPO) Plan Details

GENERAL CARE COVERAGE, DEDUCTIBLES, AND COPAYS

• No medical deductible

• $0 annual routine physical and annual routine vision exam (in-network)

• $0-10 copays for primary care office visits in-network (30% out-of-network)

• $0 copays for many preventive services (in-network)

• $0 copays for many generic drugs at Hannaford Pharmacies*

• Coverage while you travel with worldwide urgent and emergency care.

SPECIALTY VISIT COPAYS

• $40 copays for in-network specialist visits (30% out-of-network)

OUT-OF-POCKET MAXIMUMS

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.

COVERAGE OVERVIEW

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.

GENERAL COVERAGE OVERVIEW

Copays for in-network providers are as follows:

• Annual Routine Eye Exam ($0 Copay): Eye refraction to determine the need for eyeglasses/contacts, once per calendar year 

• Yearly Glaucoma Screening ($0 Copay): 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)

• Yearly Diabetic Eye Exam ($0 Copay): One diabetic eye exam (retinopathy screening) per year for people with diabetes

• Eyewear Coverage: 20% of Medicare-allowable rate for standard eyeglasses (standard frames/standard lenses) or contacts after cataract surgery that includes insertion of intraocular lens.

EYE DISEASE AND INJURY COVERAGE

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. 

EYEWEAR REIMBURSEMENT

Benefit includes up to $150 per year reimbursement for prescription lenses, frames, and contact lenses.

May be reimbursed using the Eyewear Reimbursement Request form.

COVERAGE OVERVIEW

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:

• Hearing Aids (Copays vary): Two hearing aids (one per ear) per year.
  *Copays (per ear) cost $495, $695, $1,095, $1,495, or $2,095, depending on the type of hearing aid selected

• Hearing Aid Batteries: Two years of free hearing aid batteries.

• Follow-Up Care: One year of free follow-up care for hearing aid fittings and evaluations

• Warranties: 3-year warranty on hearing devices 

*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.

COVERAGE OVERVIEW

• $275 Part D Prescription Deductible (excludes Tiers 1 & 2) prior to Initial Coverage Phase in the following areas:

MAINE: Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset and Washington counties

NEW HAMPSHIRE: Belknap, Carrol, Coos, and Grafton counties

• No Part D Prescription Deductible for Select plan members in the following areas:

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

*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.

INITIAL COVERAGE STAGE*

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.

COVERAGE GAP STAGE*

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.

CATASTROPHIC COVERAGE STAGE*

After your yearly out-of-pocket drug costs (what you paid PLUS what drug manufacturers paid) reach $7,400, you pay:

• GENERICS (including brand-name drugs treated as generic): The greater of $4.15 or a 5% coinsurance.

• OTHER: For all other drugs, the greater of $10.35 or a 5% coinsurance. 

*Different cost-sharing applies for members who receive "Extra Help" (Low-Income Subsidy (LIS/LICS))

COVERAGE OVERVIEW

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).

QUALIFYING PRODUCTS

A variety of products qualify, including those used for:

• 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.

Search and buy products online
Download the 2023 catalog (PDF)
Search OTC Benefit Pharmacy Locations

BENEFIT 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, 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.

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.

COVERAGE OVERVIEW

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.

BENEFIT OVERVIEW

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.

REIMBURSEMENT FORMS

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.

BENEFIT 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.

DISCOUNT OVERVIEW

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:

• 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

• 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

BENEFIT 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.

BENEFIT 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 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.