2022 Alliance (HMO) Plan Details

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. 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).

Alliance plan members use this form for your separate eyewear allowance. 

Member Reimbursement Request for Medical Services (PDF)

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.

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 three weeks (42 meals) per inpatient stay or surgery (no 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

The Martin’s Point Generations Advantage Dental Benefit is administered by Northeast Delta Dental (NEDD).

In-Network Only: See a Delta Dental network dentist in Maine, New Hampshire, or Vermont

• No waiting periods for coverage
• $2,500 annual benefit maximum (the maximum amount the plan will pay each year toward your covered dental services after you have paid any applicable copays, deductibles, and coinsurance)

• $0 OFFICE VISIT COPAY FOR ALL VISITS:
  • Diagnostic and preventive services include routine cleanings (twice per calendar year), exams, and X-rays and are covered with no coinsurance/deductible
  • Basic restorative services include amalgam (silver) fillings (additional costs may apply for resin fillings, please reach out to Northeast Delta Dental for more information), oral surgery, root canals, and periodontal maintenance and are covered with 20% coinsurance and no deductible
  • Major restorative services include dentures, bridges, crowns, onlays, and implants and are covered with 50% coinsurance and no deductible

• 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). 

Your flexible Wellness Wallet benefit reimburses up to your plan’s annual amount for a wide range of eligible gear, fees, and services that help keep you active and well.

On our Wellness Wallet Information page, you will find

• Your plan’s annual reimbursement amount and list of reimbursable items
• How to use your Wellness Wallet benefit
• Wellness Wallet FAQs

2022 Wellness Wallet Reimbursement Form (PDF)

This form is for any services covered under your 2022 Wellness Wallet reimbursement benefit. To be eligible for payment, the date of service or purchase must be in 2022 and you must submit your claim by March 31, 2023.

What you pay when you get these services in network:

• $0: Annual routine eye exam (eye refraction) to determine the need for eyeglasses/contacts, once per calendar year.
• $0: Medicare-covered, non-routine outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration.
• $0: One glaucoma screening each year for people who are at high risk of glaucoma (includes people with a family history of glaucoma, people with diabetes, African Americans who are age 50 and older and Hispanic Americans who are 65 or older).
• $0: One diabetic eye exam (retinopathy screening) per year for people with diabetes.
• 20% of Medicare-allowable rate for standard eyeglasses (standard frames/standard lenses) or contacts after cataract surgery that includes insertion of intraocular lens.

Reimbursement up to $400 for prescription frames, lenses, and contacts

• Alliance plan members use this form for your separate eyewear allowance.
• Member Reimbursement Request for Medical Services (PDF)

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
• Hearing aid copays (per ear): $295, $495, $895, $1,295 or $1,895. ⁵Copays 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, 8 am–8 pm, Monday through Friday to get started: 1-855-533-7486 (TTY: 711)

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

• 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).

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.

Screening Test	How Often4	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 Sigmoidoscopy4 OR Screening Barium Enema	Every four years	At facility
Colonoscopy4 Screening	Every 10 years	At facility

Members receive a quarterly amount to purchase from over 350 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)

Martin’s Point Health Care has teamed up with Foodsmart™ to provide you with free, unlimited chats with a nutrition coach—plus much more—to support healthy eating from the comfort of home by telephone or online. You don’t need to use your health plan’s Wellness Wallet reimbursement program to take advantage of this benefit as your Generations Advantage plan covers 100% of the program cost. The Foodsmart program is tailored to your individual needs and preferences—from nutrition tips for managing a medical condition, to simply wanting to eat healthier, or just trying to save on groceries. Your Foodsmart nutrition coach and other resources can make healthy eating easier and more affordable.

To get started, call 1-888-837-5325 to schedule an appointment with a nutrition coach. 

If you prefer to reach out online, you can:

• Visit https://www.foodsmart.com/martinspoint to sign up. If you are having online difficulties signing up, call 1-888-837-5325 for technical support. 
• Send an email requesting an appointment to [email protected].
• Download the Foodsmart app in the App Store or Google Play. Click on “Sign Up.” Your Group is “Martin’s Point Generations Advantage.”

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 Carenet Healthcare Services 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.