Alliance (HMO) Plan Details 2021

Please note: You cannot have a separate Medicare Part D Prescription Drug plan if you enroll in the Alliance plan.

• $0 monthly premium
• Save $60 monthly with Part B Premium Reduction. Members must continue to pay the remaining portion of their Medicare Part B premium
• No deductibles
• $0 annual routine physical and annual routine vision exam (in-network)
• $0 copays for primary care office visits
• $0 copays for a range of preventive services
• $5 copays for specialist visits
• $0 copay for outpatient rehabilitation services (physical therapy, occupational therapy, speech pathology)
• $20 copay for routine chiropractic services
• $0 copay for personal emergency response system
• $5,000 out-of-pocket maximum ($8,000 combined in and out-of-network). Note: Plan premium does not count toward this maximum.
• Emergency care coverage worldwide
• Urgent care coverage worldwide

*Note: This is not a comprehensive list of plan benefits, please refer to the Evidence of Coverage (EOC) for a full list of plan benefits.

*Members must use in-network providers for most services.

Prescription Eyewear

You receive a $400 allowance toward lenses and frames (including standard contact lenses).

Chiropractic Services

Covers routine chiropractic services:

• You pay $20 copay for routine (maintenance) chiropractic manipulations and office visits.
• Routine services may include conservative management of neuromusculoskeletal disorders and related functional clinical conditions including, but not limited to, back pain, neck pain, and headaches.
• Services must be received from a state-licensed chiropractor practicing within the state’s licensure and practice guidelines.
• X-rays are not covered when rendered in a chiropractor’s office.

Medical Alert Devices and Monitoring

Administered by LifeStation

• You pay a $0 cost share for medical alert device.
• Receive your choice of an in-home system (land line or cellular that can be used only in the home) or a mobile system with location services which can be used outside of the home.
• Fall-detection option is available (automatically alerts LIFESTATION that you have fallen, even if you do not press the emergency button).
• Includes product warranty on all service plans ($5 per month value at no charge).
• Spousal coverage is available on all in-home units ($3.99 per month value at no charge).

Bathroom Safety

Allowance for bathroom safety devices and installation:

• You receive a $400 allowance for bathroom safety devices, including shower seats, safety bars, transfer benches, and other items.
• Covers installation of devices and an in-home bathroom safety inspection by a qualified health professional to identify the need for safety devices and the applicability to your bathroom.
• Please see the Evidence of Coverage for your plan or call Member Services for a full list of covered devices.

Meal Delivery

Administered by Mom's Meals

Receive home-delivered meals tailored to your individual health and dietary needs after an inpatient stay or surgery:

• Meals are fully prepared and ready to go in the refrigerator when they arrive on your doorstep.
• You pay nothing for up to one week (14 meals) per inpatient stay or surgery (four weeks maximum per year).

Call Martin's Point Care Management for more information 1-877-659-2403.

Fall Prevention

You get a $50 allowance to attend an evidence-based falls prevention program supported by the National Council on Aging (NCOA), such as a Matter of Balance or YMCA Moving for Better Balance.
PLEASE NOTE: We will provide information to you about classes sponsored by Martin's Point that may be available near you.

Smoking Cessation

You pay $0 for two additional smoking cessation classes beyond what Medicare covers.

Health Education

All plan members qualify for health coaching, disease support groups, and nutritional cooking classes.
Call Member Services for more information 1-866-544-7504.

Counseling

You pay $0 for one counseling visit per year for counseling services not covered by Original Medicare. Session can be individual or group therapy services to address non-Medicare-covered general topics, such as: coping with life changes, conflict resolution, or grief counseling

View Disclaimers

• No waiting periods for coverage
• $5 office visit copay
• Fully covered diagnostic and preventive services with no coinsurance or deductible includes cleaning, exams, and X-rays
• Basic restorative services are covered with 20% coinsurance and no deductible, includes fillings, oral surgery, root canals, and periodontal maintenance
• Major restorative services are covered with 50% coinsurance and no deductible, includes dentures, bridges, crowns, onlays, and implants
• $2,000 benefit maximum

• If you get the shot at your primary care provider’s office, you may have to pay a copayment for the office visit, but there will be no cost for the flu shot.
• If you get the shot at a pharmacy, you will have to pay for the vaccine up front and then request a reimbursement from your plan.
• Shots include Quadrivalent, Trivalent, Trivalent (high dose), and Intradermal.

Download the reimbursement form HERE (PDF). 

• Fitness services, gym membership, personal trainer fees at a facility, fitness classes, fitness equipment, outdoor bicycles, bicycle repair, sport leagues, bowling, ski passes/skis, exercise sneakers and hiking boots
• Wearable fitness tracker (including Apple Watch and other smart watches)
• Acupuncture and naturopathic services through a licensed naturopathic doctor (homeopathy and hypnotherapy do not qualify.²
• Nutrition and dietary benefit²
• Weight management programs

Please note this is not a complete list. If you have any questions about an item/service, please call Member Services to confirm it is covered.

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).
• Exclusions: N95 respirators, homemade cloth mask supplies.

Download your reimbursement form to mail in:

2021 Wellness Wallet Member Reimbursement (PDF)

The 2020 form is for any services covered under your 2020 Wellness Wallet reimbursement benefit. To be eligible for payment, the date of service or purchase must be in 2020 and you must submit your claim by March 31, 2021. 

2020 Wellness Wallet Member Reimbursement (PDF)

• $0 for annual routine eye exam
• $0 for non-routine Medicare-covered physician services
• $0 for glaucoma testing
• $0 for a diabetic eye exam (retinopathy)
• Reimbursement up to $400 for prescription frames, lenses, and contacts

Amplifon will help you find a hearing aid provider near you, explain the process, help you schedule an appointment, and send information to you and the provider, ensuring your discount is applied. Your coverage includes:

• Two hearing aids (one per ear) per year
• Alliance plan copays are: $295, $495 or $895 per ear.³ Copays vary based on the type of hearing aid selected.
• Two years of free hearing aid batteries
• One year of free follow-up care for hearing aid fittings and evaluations
• 3-year warranty on hearing devices

Call Amplifon between 8 am–8 pm, Monday through Friday to get started: 1-888-669-2167 (TTY: 1-763-268-4264)

*These benefits are only available when purchasing a hearing aid through the Martin’s Point-Amplifon program.

• Choose an in-home system (landline or cellular that can be used only in the home), or a mobile system with location services which can be used outside of the home.
• Fall-detection option available for an additional fee (automatically alerts LifeStation that you have fallen, even if you do not press the emergency button)
• Product warranty on all service plans (a $5 per month value at no charge)

For more information, call LifeStation at: 1-866-220-0934.

Talk to your doctor about which screening is right for you—all have $0 copay when you go to an in-network provider.

Members receive a quarterly amount to purchase from over 300 CVS brand, over-the-counter products, including:

• Smoking cessation: Nicotine replacement patches
• Oral health: Toothpaste, toothbrushes, floss
• Pain relief: Ibuprofen, acetaminophen
• Allergy: Allergy relief tablets
• Cold remedies: Cough drops, daytime/nighttime cold medicine
• Digestive health: Heartburn relief tablets, daily fiber
• First aid: Bandages
• Incontinence: Bladder control products

You may make a purchase in-person at participating CVS locations, over the phone by calling OTC Health Solutions at 1-888-628-2770 (TTY: 711), or online.

Search and buy products online. 
Download the catalog (PDF)
Search OTC Benefit Pharmacy Locations

Note that unused quarterly amounts are forfeited (do not roll over into the next quarter)

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:

• Manage your health care
• Navigate your health plan
• Understand medications
• Find community support and resources

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:

• If a cut requires stitches
• If you should head to an urgent care clinic, the ER, or wait until morning to see your doctor
• General information about a condition, medication, or other health concerns

This service is provided by SironaHealth in partnership with Martin's Point. This service is not intended to take the place of your primary care provider. 

At Martin’s Point, we are committed to providing our members a fair and timely process for resolving any complaints or disputes. We encourage Martin’s Point Generations Advantage members to contact us with questions, concerns, or problems related to any benefits or service. Please call us at 1-866-544-7504 (TTY: 711), 8 am to 8 pm, seven days a week from October 1–March 31, and Monday through Friday the rest of the year, to discuss your concerns.

For more information on this process, please visit our Grievances & Appeals page.