Helping you understand your health coverage and use your plan benefits.
Find information on using your benefits, reimbursements, and key plan documents and forms to help you make the most of your health plan.
Member Resources
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Health Programs & Benefits
Looking for Part D or Extra Benefits?
For information on these benefits, please visit the Pharmacy & Part D Coverage and Extra Benefits pages.
Explore added benefits and programs for screenings, therapy drugs, personalized care management, and more.
Health Risk Assessment (HRA)
Take your free Health Risk Assessment—an online questionnaire to help you understand your health/health risks, and guide you toward being as healthy as possible.
To take the HRA, you must first have an online portal account. Log in with your portal username and password or click “Register” if this is your first time logging in. When prompted, enter your Generations Advantage member ID number and follow the instructions. This website will allow only you to see your results anytime.
If you don’t have internet access or have questions, call us at 1-877-659-2403 (TTY: 711) and leave a message. We will return your call within two business days.
You can find the Health Risk Assessment here:
After-Hours Care
Unsure what type of care you need? See our Care Guidance page for more information on after-hours care options.
Telehealth Services
Included Health, Inc. administers telehealth services for health plan members and covered dependents, providing online access to urgent care and behavioral health support 24/7/365. Connect with a doctor, from the comfort of home or wherever you currently are.
To use this service, download the mobile app and access telehealth services here:
IncludedHealth.com/MartinsPoint
Urgent Care Clinics
Visit an Urgent Care Clinic for non-life-threatening conditions requiring prompt attention that can't be addressed by your PCP. Your plan covers urgent care services worldwide, even if the facility is not in-network.
To find your local urgent care clinic, use the search tool:
24-Hour Nurse Line
Talk with a trained nurse anytime, 24 hours a day, 7 days a week, for general health questions or advice, guidance on where to go for care, to discuss care options, etc. 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.
Call the 24-Hour Nurse Line: 1-800-530-1021
Personalized Care Management
As a Martin’s Point Generations Advantage member, you are eligible to receive free, personalized care management.
Your care manager will help you better understand your conditions and work with you to set achievable goals related to your health. We will also stay in touch with your doctor to make sure they are informed.
Care management may help if:
- You have complex, chronic, or multiple medical conditions
- You've recently had a serious injury
- You want help managing your care
- You are struggling with drug or health care costs
- You are in an unsafe home environment
- You face challenges such as lack of family support, transportation, etc.
Care management services include:
- Assistance with transitions of care
- Care support for chronic and/or mental health conditions
- Understanding your medications
- Obtaining necessary medical equipment, such as a wheelchair or other items
- Assistance with navigating the health care system
- Finding community resources
Ready to get started? Care management assessements are conducted over the phone. To sign up with a medical or mental care manager, please call 1-877-659-2403.
For detailed coverage information, visit:
Part B Drug Coverage
Part B is a medical benefit that covers medications and treatments when they are provided as part of a Medicare-covered service. Coinsurance applies and ranges from 0% to 20% of the total drug cost and varies by drug, service, and plan.
These specialized medications are usually given as injections or infusions to treat certain health conditions and are typically administered by a health care professional in a doctor’s office, hospital, or clinic. The drug must be medically necessary to qualify for coverage under this benefit.
Covered drugs include:
- Transplant/immunosuppressive drugs
- Injectable or intravenous drugs
- Certain oral drugs for cancer treatment
- Drugs requiring durable medical equipment (e.g.: a pump or nebulizer)
Other Part B coverage:
- Insulin administered with a medically-necessary insulin pump
- Certain vaccines are covered under Medicare Part B—Learn more about vaccine coverage
Some Part B drugs require prior authorization before they are covered.
In addition to prior authorization, members taking non-preferred Part B drugs may be subject to Step Therapy to transition to an equivalent preferred drug, if available. If the preferred drug isn't effective or causes side effects, your doctor can request authorization for the non-preferred drug.
View the current list of preferred and non-preferred Part B drugs:
2026 Part B Drugs & Biologics Step Therapy List [PDF]
2027 Part B Drugs & Biologics Step Therapy List [PDF] - Coming Soon
For more details about Part B drug coverage and related services, please refer to your Evidence of Coverage (EOC).
Looking for Part D Information?
Part D Step Therapy drug information and documents—Part D Step Therapy
Part D insulin coverage information and copays—Part D Insulin Coverage
Cancer Screenings
For detailed coverage information, refer to your Evidence of Coverage document.
Breast Cancer Screenings
Doctors use mammograms to detect breast cancer. There are two types of mammography used to screen for breast cancer:
- Conventional (2D) Mammography
- Digital Breast Tomosynthesis (DBT)—also known as 3D mammography
Your plan includes annual coverage for a three-dimensional DBT mammography for all women age 40 and older.
Cervical Cancer Screenings
It is recommended that individuals should be screened for cervical cancer every three to five years (depending on the testing method). These screening tests can be done in a doctor's office or clinic.
Two screening tests help detect cervical cancer:
- The Pap (Papanicolaou) Test—this test looks for precancers, which are cellular changes that could become cancer if not treated. If result is normal, wait three years for next test.
- The Human Papillomavirus (HPV) Test—this test looks for HPV cells that are most likely to cause cervical cancer. If result is normal, wait five years for next test.
Colorectal Cancer Screenings
All screenings have a $0 copay when you go to an in-network provider. We cover these screenings more frequently for people at high risk for colorectal cancer.
There are various screening options—ask your primary care provider which screening and schedule is right for you:
Screening Test |
How Often |
Mode of Screening |
|---|---|---|
|
Fecal Occult Blood Test—gFOBT, iFOBT Fecal Immunochemical Test—FIT |
Every calendar year |
At home |
|
DNA-based Test—Cologuard® |
Every three years |
At home |
|
Flexible Sigmoidoscopy |
Every five years |
At a health care facility |
|
Screening Barium Enema |
Every five years |
At a health care facility |
|
Colonoscopy Screening |
Every 10 years |
At a health care facility |
Flu Shot Benefit
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.
Network Pharmacy
No cost to you if received at CVS, Hannaford, Walmart, Shaw's/Osco, or Walgreens pharmacies.
PCP/Doctor's Office
You may have a copay for the office visit depending on your plan, but there will be no cost for the flu shot.
Out-of-Network
You will pay the full cost of vaccines received at OON pharmacies and submit to us for reimbursement.
If you don’t have your Generations Advantage member ID card with you when you get your flu shot, you will pay the full cost at the pharmacy and submit to us for reimbursement.
Medical Services 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.
For detailed coverage information, visit:
*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.
LifeStation® Medical Alert Devices
At Martin's Point, we’ve partnered with LifeStation to offer peace of mind and security through advanced medical alert devices.
Your benefit type depends on what Generations Advantage plan you are enrolled in:
Medical Alert Device Discount
For Prime, Select, and Essential plan members
Plan members receive 25% discounts on medical alert devices through LifeStation. Please note this is a value-added discount, not a covered plan benefit.
Devices & Pricing
- In-home landline—$19.95/month
- In-home cellular—$29.95/month
- Mobile unit with GPS/Wi-Fi—$29.95/month
- Fall detection optional add-on—$5.00/month
What's Covered
- Shipping and activation fees
- Monthly charges for device and monitoring
- Optional accessories, including a smartwatch, can be offered at additional rates.
For more information, visit LifeStation Discount Benefit.
Ready to enroll? Call LifeStation at 1-855-793-8555. You will be asked to provide a credit card or bank account for automatic deductions of monthly charges for the device and monitoring.
Covered Medical Benefit
For Alliance plan members only
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.
Device Options Available
- In-home landline system
- In-home cellular system
- Mobile unit with GPS/Wi-Fi
- Fall detection add-on to any device
What's Covered
- Shipping and activation fees
- Monthly device and monitoring fees
- Spousal coverage for in-home devices
- Product warranties
For more information, visit LifeStation Medical Benefit.
Ready to enroll? Call LifeStation at 1-866-220-0934. Be sure to have your Generations Advantage Member ID ready.
Mom's Meals Program
Mom's Meals allows eligible members to purchase nutritionally balanced, ready-to-eat meals that are delivered directly to your home. The program features a menu with 60+ microwaveable entree options designed by chefs and registered dietitians to support wellness goals or specific nutritional needs.
Program eligibility and benefits depend on which Generations Advantage plan you are enrolled in:
Alliance plan:
- Available to all Alliance plan members
- Up to three weeks (42 meals) per inpatient stay or surgery event
- Up to one week (14 meals) per year for members with chronic health conditions (such as diabetes or COPD) as part of a lifestyle modification program
Prime, Select, Essential plan:
- Available only for members with congestive heart failure or end-stage renal disease who meet criteria
- Up to one week (14 meals) per post-surgery/discharge event
- Option for an additional week (14 meals) when high risk is identified
Using the code MPGA to activate this offer, place your order onlineor by calling 1-877-347-3438.
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Member Services & Support
Additional plan details including third-party vendor information, state resources, grievance support, and more.
Coverage Decisions & Criteria
There are several factors that impact whether a service or procedure is covered under a member’s benefit plan.
Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. This information is available to plan members as a reference when interpreting claim decisions.
For detailed information on coverage decisions, visit:
Plan Premiums
Most Generations Advantage plans have a plan premium. You must pay this fee every month, whether you go to the doctor, use medical care, or make a claim.
Premium amounts vary by plan. To find out your Plan Premium, please refer to the "Benefits Overview" tab on your plan detail page.
Note: Alliance plan members do not have a monthly plan premium
Paying Your Premium
We make paying your monthly plan premium easy. There are two options:
Premium AutoPay
Set up automatic, recurring payments processed during the first week of each month.
You will need:
- Member ID card
- Date of birth
- Payment method (Social Security/RRB, bank account, or credit/debit card)
Prefer mail? Fill out the Automatic Payment Form and mail it to Martin's Point.
One-Time Payments
Make secure, one-time payments 24/7 using a credit or debit card.
You will need:
- Member ID card
- Billing address
- Invoice Account Number (ARAC)
- Credit or debit card
(For one-time payments, you will be redirected to our secure payment vendor site)
Maximum Out-of-Pocket (MOOP) Guide
Your Maximum Out-of-Pocket limit is the most you will pay for covered medical services in a fiscal year. Once you reach your Maximum Out-of-Pocket limit, you will no longer pay cost shares for those services.
What counts toward MOOP?
- Medical service copays
- Medical service coinsurance
- Durable medical equipment (DME) cost shares
What does not count toward MOOP?
- Dental service cost shares
- Hearing aid cost shares
- Wellness Wallet and Eyewear allowances
- Plan premium payments
- Part D prescription drug cost shares
To find out your Maximum Out-of-Pocket limit, please refer to the "Benefits Overview" tab on your plan detail page.
To check if you’ve hit your limit, contact Member Services at 1-866-544-7504. If you have reached your Maximum Out-of-Pocket, you may request a letter which can be shown at your doctor's office to confirm that you no longer need to pay cost shares.
Third-Party Vendors
We connect you directly with trusted partners, making it easier than ever to manage your benefits. From exclusive discounts to personalized support, our vendors are here to help you get the most out of your membership.
A full list of our third-party vendors is available here:
Grievances & Appeals
At Martin’s Point, we are committed to providing our members with a fair and timely process for resolving any complaints or disputes. We encourage Martin’s Point Generations Advantage members to reach out with questions, concerns, or issues related to their benefits or services.
Filing a Grievance
If you’re unhappy with a service, provider experience, or any aspect of your care, you have the right to file a grievance. It’s your way to let us know something didn’t go as expected. We take your concerns seriously and will investigate and respond.
There are two options for submitting a grievance:File by Phone:
Representatives are available from 8 am–8 pm
October 1 to March 31—Seven days a week
April 1 to September 30—Monday to Friday
1-866-544-7504 (TTY: 711)
File Online:
Grievances may be filed online by using the Medicare Complaint Form, which submits certain plan complaints directly to Medicare.
For detailed information about filing a grievance:
Filing an Appeal
As a Martin's Point health plan member, you have the option to appeal our decision not to cover a service, drug, vaccine, or other benefit. You can also authorize someone else, such as a provider or family member, to file an appeal for you.
Your appeal must be made within 65 days of the denial notice. All appeals must be made in writing (however, oral appeals are accepted if you are unable to submit your request in writing).
We will review your case and send you a decision by mail.
For detailed information about filing an appeal:
21st Century Cures Act
As part of the 21st Century Cures Act regulations, the Centers for Medicare and Medicaid (CMS) policy now requires that systems be put in place to make it easier for you to see your important health data.
Under the 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
For detailed information about your rights and data privacy, visit:
Helpful Medicare Contacts
Social Security Office
Website: SSA.gov
Phone: 1-800-772-1213 | TTY/TDD: 1-800-325-0778
Medicare Office
Website: Medicare.gov
Phone: 1-800-MEDICARE (1-800-633-4227) | TTY/TDD: 1-877-486-2048
MaineCare (Medicaid)
Website: Maine.gov/MaineCare
Phone: 207-287-2674 | TTY/TDD: 711
Maine State Health Insurance Assistance Program (SHIP)
Website: Maine.gov
Phone: 1-800-262-2232 | TTY/TDD: 1-800-606-0215
Maine Low Cost Drugs for the Elderly/Disabled & Maine Rx Plus
Website: Maine.gov | MaineRxPlus
Phone: 1-866-796-2463 | TTY/TDD: 1-800-423-4331
Need help? We're here for you.
Whether you’re exploring plan options or already a Generations Advantage member, our team is ready to help.
Prospective Members: Call us at 1-844-300-0160 (TTY: 711)
Current Members: Call Member Services at 1-866-544-7504 (TTY: 711)