This information is for Generations Advantage members.
The following is an overview of COVID-19-related benefits during and after the PHE period. Effective date for changes occurring after the PHE ends is May 12, 2023. See your plan’s Evidence of Coverage for details. If you have questions about your coverage, don’t hesitate to contact Member Services at 1-866-544-7504. We’re here for you!
DURING AND AFTER THE PHE ENDS: Make sure to bring your Martin’s Point Generations Advantage identification card as your Generations Advantage plan is the primary payer for COVID-19 vaccines. You won’t pay a copay for a COVID-19 vaccine and, if your plan has a prescription deductible, your deductible will not apply to the cost of the COVID-19 vaccine.
For information on the distribution and availability of the COVID-19 vaccine, please visit https://www.vaccines.gov/search.
DURING THE PHE: Tests done at a test facility or doctor’s office are covered if they are medically necessary—this includes if you have COVID-19 symptoms or are symptom-free but have been exposed to someone with COVID-19.
**Travel- or work-related tests are not covered.**
Find a test site at your state’s health department website:
DURING THE PHE: If you are diagnosed with the Coronavirus (COVID-19), copays/coinsurance will be waived for the following services if related to COVID-19:
AFTER THE PHE ENDS: If you are diagnosed with the Coronavirus (COVID-19), copays/coinsurance will only be waived for the following COVID-19 treatments:
For all other services, cost sharing will apply based on your plan benefits.
DURING THE PHE: Following guidance from The Centers for Medicare and Medicaid Services (CMS), during the declared Public Health Emergency, all medical services normally covered by your plan at in-network levels will be covered with in-network member cost shares, even if you receive them from out-of-network providers. This applies to all Generations Advantage plans.
AFTER THE PHE ENDS: (Effective starting May 12, 2023): Network requirements will return for all services except those designated by CMS, and cost-sharing will be applied based on the member’s plan benefits.
Generations Advantage Prime (HMO-POS) and Select (PPO) plans–covered out-of-network services are subject to out-of-network cost shares. (See Exception*).
Generations Advantage Value Plus (HMO), Alliance (HMO) and Focus DC (HMO SNP) plans— there is no coverage for services performed by out-of-network providers (See Exception*).
*EXCEPTION for ALL Generations Advantage plans: Urgent and emergency care are always covered with in-network cost shares, even if received out of network. In addition, if there are no in-network providers who can deliver a particular service in your area, the service can be evaluated by the health plan for in-network cost sharing.
DURING THE PHE: Generations Advantage covers all telehealth services covered by Original Medicare. Due to the COVID-19 outbreak, Medicare has relaxed their requirements for telehealth services to allow members to get needed care. Copays for any telehealth services related to COVID-19 will be waived.
For all other visits, the in-network primary care copays will apply for telehealth services with a primary care provider, and in-network specialist copays will apply for telehealth services with a specialist. These copay amounts will be the same as if you received care through an in-office visit.
AFTER THE PHE ENDS: Generations Advantage will continue to cover all telehealth services covered by Original Medicare. Cost-sharing for any telehealth service will apply based on your benefit plan. These copay amounts will be the same as if you received care through an in-office visit.