Below you will find a summary of your coverage and benefits as well as key documents and extra plan benefits.
You can see out-of-network doctors for all covered medical services, though you pay less for in-network doctors.
A look at your plan benefits, copays/costs, important documents, and more.
Generations Advantage Select (LPPO) Plan in-network coverage includes:
OUT-OF-POCKET MAXIMUMS: $6,750 combined in- and out-of-network
PRIMARY CARE OFFICE VISIT COPAY: $10
SPECIALIST OFFICE VISIT COPAY: $40
URGENT CARE COPAY: $50 in-country and $100 out-of-country
EMERGENCY CARE COPAY: $100 for both in- and out-of-country
INPATIENT HOSPITAL STAY COPAY: $340 per day for days 1-7, and $0 per day for days 8+
NOTE: The Select plan DOES NOT include Dental Benefits.
Your plan includes Medicare Part D Prescription Drug coverage.
Drug costs can vary by tier, source (where you fill your prescriptions), and by phase of coverage. More information can be found here in the Pharmacy & Prescription Resources section.
Is my prescription covered?
Each plan has its own formulary—a list of drugs covered by the plan. Members can use the Formulary Search Tool find coverage information for a specific medication:
Prefer a hard copy? Download a PDF copy of the Comprehensive Drug Formulary here:
Ready to get reimbursed? Download the 2024 Prescription Drug Reimbursement Form here to get started:
Prescription Reimbursement Form
PRESCRIPTION DEDUCTIBLE: $275*
*Includes drugs in Tiers 3, 4, and 5
PRESCRIPTION COPAYS: Below is a summary of drug copays with preferred, standard, and mail-order cost-sharing:
INSULIN COPAYS: Insulin copays are the same at all pharmacies (preferred, standard, and mail order):
Your Martin’s Point Generations Advantage plan offers extra vision benefits that go beyond Original Medicare.
Coverage includes:
What is covered under the eyewear reimbursement benefit?
The eyewear reimbursement benefit covers prescription lenses, frames, and contact lenses. For more information, including a full list of covered items/services, go here:
Ready to get reimbursed? Download the 2024 Eyewear Reimbursement Form here to get started:
2024 Member Reimbursement Form
EYEWEAR AFTER CATARACT SURGERY: If you've had recent cataract surgery, we've got you covered.
Learn more here: Eyewear After Cataract Surgery
The Hearing Benefit goes beyond Original Medicare to provide coverage for hearing aids/batteries.
Generations Advantage members have an extra hearing benefit through Amplifon.
Members are required to use an Amplifon network provider to receive coverage. Amplifon will work with you to find a network provider in your local area.
*There is a 3-year warranty included for all hearing devices
Ready to get started?
Call Amplifon to get started at1-888-669-2167 (TTY: 711).
For more information, visit the Hearing Aid Benefit page.
Use your Wellness Wallet to help you stay fit and healthy!
For more information, visit the Wellness Wallet page.
Does my item qualify for reimbursement?
The Wellness Wallet benefit reimburses you for a wide range of eligible gear, fees, and services. A list of covered items/services can be found here:
Ready to get reimbursed? Download the 2024 Wellness Wallet Reimbursement Form here to get started:
Members receive a quarterly amount to purchase from over 350 CVS-brand, over-the-counter products.
Unused amounts DO NOT roll over into the next quarter.
For more information, visit the OTC Benefit page.
Purchases can be made in person at participating CVS retail locations, by phone, or online up to your plan's quarterly allowed amount.
What items are covered?
Members can use the OTC Catalog Search Tool to search for covered items online:
A quick guide to premium payments, health screenings, nutrition coaching, emergency care, and more.
It's easy to make a one-time credit card payment. Simply click the button below to securely pay your premium.
To set up secure, recurring payments, please call Member Services or mail us a completed and signed Automatic Payment Form.
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.
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.
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.
At Martin's Point, we’ve partnered with LifeStation to offer peace of mind and security through advanced medical alert devices. LifeStation ensures you're always connected when it matters most.
GENERATIONS ADVANTAGE DISCOUNT ON MEDICAL ALERT DEVICES
Generations Advantage plan members (Access, Select, Prime, and Value Plus) receive 25% discounts for medical alert devices through LifeStation. Please note, this is not a plan benefit and is instead a value-added discount.
How to Access Your Value-Added Discount:
What’s Covered:
Devices & Pricing:
MANAGING YOUR LIFESTATION SERVICE
Once enrolled in either option, LifeStation makes it easy to manage your service and get support when you need it:
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 Health in partnership with Martin's Point. This service is not intended to take the place of your primary care provider.
*Every year, Medicare evaluates plans based on a 5-star rating system. Medicare’s highest 2025 rating awarded for MA (HMO, HMO-POS, LPPO) style plans in Maine and New Hampshire is 4 out of 5 stars. Generations Advantage 2025 Overall Ratings: 4 out of 5 Stars for HMO Contract #H5591 (includes HMO-POS) and 3 out of 5 Stars for LPPO Contract #H1365. Visit Medicare.gov for more information.