Generations Advantage

We’re here for you.

During these challenging times, it’s comforting to know that all of us at Martin’s Point Generations Advantage are here for you. We understand that our members are dealing with many concerns during the current coronavirus outbreak. We want to make sure your health coverage isn’t one of them.

Helping You Understand Your Benefits during the COVID-19 Outbreak

You’ll be reassured to know that the Centers for Medicare and Medicaid (CMS) have made some benefit changes to Medicare to support the health of members during the COVID-19 outbreak. Below, you’ll find information about those changes and how your Generations Advantage plan covers health care services during this time.

Testing: Labs used to directly test for the Coronavirus (COVID-19) are covered at no cost to you. This includes the collection of the sample and the lab analysis.

Treatment: If you are diagnosed with the Coronavirus (COVID-19), copays/coinsurance will be waived for the following services if related to COVID-19:

• Emergency room visits
• Urgent care visits
• Office visits
• Telehealth services.

Hospital Coverage: If you are admitted to a hospital, the standard inpatient copay will still apply.

Out-of-Network Cost Shares During COVID-19 Public Health Emergency:  During the declared Public Health Emergency, all plan-covered, out-of-network services will be processed at the in-network member cost shares to follow guidance from The Centers for Medicare and Medicaid Services (CMS). Once the Public Health Emergency has officially ended, members receiving covered out-of-network services will be subject to out-of-network cost shares. To help with this transition, Generations Advantage will continue to apply in-network member cost shares to covered services received from out-of-network providers for an additional 30 days. If you need help finding an in-network provider, you can search the provider directory or contact Member Services at 1-866-544-7504.

• For Alliance (HMO) Plan & Focus DC (HMO SNP) Plan Members: There is no coverage for non-emergency and non-urgent care services performed out of network.
• For Flex (RPPO) Plan Members: Non-emergency and non-urgent care services performed out of network will incur out-of-network cost shares if the service takes place outside of Maine or New Hampshire.

Telehealth: 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. Members can now use readily available platforms, like Skype and Facetime, to receive care from their providers. Visits by telephone are also permitted, when appropriate. 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.

Face Masks for Protection

Effective 4/24/2020, face masks are now covered under the Wellness Wallet and subject to your benefit maximum. Masks must be purchased through a website, retail store, or Durable Medical Equipment (DME) provider. The approved benefit includes:

• Cloth masks
• Surgical masks are now covered (limit 50 per month to reserve supplies for health care workers and medical first responders).
• Other exclusions: N95 respirators, homemade cloth mask supplies.

If you have questions about your coverage, don’t hesitate to contact Member Services at 1-866-544-7504. We’re here for you!