Understanding Medicare: Get the Care You Need, Wherever You Are

Posted 7/15/2021

When it comes to Medicare Advantage plans, getting coverage for medical care beyond your home base can create a lot of confusion. Too often, this lack of understanding leads people to overpay, miss out on benefits, and pass up the local, friendly service they deserve. We’d like to dispel some common myths about so-called out-of-network coverage, so you have the facts you need to choose the best health plan for your needs.

I live in Maine, but my wife and I travel a lot. We can’t join a Martin’s Point Generations Advantage plan because we might need urgent care while we’re out of the state or country.

Fact: All our Generations Advantage plans – whether they are an HMO, HMO-POS, or PPO plan—cover you for urgent and emergency care, anywhere in the world. Feel dizzy while sightseeing in Rome and need to see a doc? Twist your ankle and need an urgent X-ray in Arizona or Mexico? No problem. We have your back.

First and foremost, although Martin’s Point Generations Advantage plans serve people who have legal residence in Maine and New Hampshire, that does not mean your medical care is only covered in these states! It’s an understandable misconception, but it’s simply not true. In fact, our plans have varying degrees of flexibility to see the provider of your choice—and every single one of our plans covers urgent and emergency care, wherever you are.

So, that unexpected something you worry about happening away from home? With Martin’s Point Generations Advantage, you’re covered.   

I live in Florida part of the year and need to have lab work done regularly, so I can’t join Martin’s Point’s most popular plan, the Generations Advantage Prime (HMO-POS) plan

Fact: Generation’s Advantage Prime gives you the best of both worlds. There are requirements about receiving certain types of care in our network, but members can also have an out-of-network PCP, see out-of-network specialists, have outpatient surgery, get chemotherapy and radiation treatments, and more. By seeing our in-network providers for your primary and preventive care, as well as planned inpatient services like that hip replacement you need, you help keep your costs down. In general, planned out-of-network services have higher cost shares.

I live in New Hampshire, but I want to keep my primary care provider in Massachusetts, so I can’t join Martin’s Point Generations Advantage.

Fact: With our PPO-style plans you have the flexibility to see any provider or facility that accepts Medicare, anywhere in the United States—including that PCP in Massachusetts.  Generation’s Advantage offers you two PPO options. With both our Flex (RPPO) and Select (LPPO) plans, we separate health care into two tiers, so you pay one cost share for in-network care and a higher cost share for out-of-network care. This allows us to manage costs, and still give you maximum choice.

If value is your top priority, one of our HMO plans might suit you best. These plans have tighter rules about out-of-network care to help keep your costs down. But because our wide provider network is packed with options, most of our members report they still enjoy plenty of choice. These options include Generations Advantage Prime (HMO-POS), Alliance (HMO), Value Plus (HMO), and Focus DC (HMO-SNP)—a special needs plan designed for people with diabetes who live in Cumberland County.

Finding it hard to choose? “I always ask prospective members why they might want out-of-network care,” says Stephanie Plourde, who helps people navigate Medicare choice for Martin’s Point every day. “This helps people pinpoint real-life needs and figure out which plan covers them best. It’s also comforting for people to know that, again, all of our plans cover them for emergency and urgent care, in any situation.”