There is a $275 prescription deductible for Tiers 3–5 drugs only. There is no deductible for Tiers 1 and 2 medications; you only pay a small copayment or coinsurance.
For Tiers 3, 4 and 5, you pay the full cost of the drug until you reach your $275 deductible.
Flex | Formulary Search |
Flex Plan Comprehensive 2021 Formulary (PDF) |
Tier | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* | $2 | $10 | $40 | $95 | 28% of cost |
Pharmacies with Standard cost sharing, 30-day supply* | $4 | $18 | $47 | $100 | 28% of cost |
Mail-order, 90-day supply | $0 | $20 | $100 | $237.50 | 28% of cost |
What you pay for your drugs depends on the drug tier, what “drug payment phase” you are in when you get the drug, and which pharmacy you use.
Deductible Phase
You begin this phase when you fill your first prescription of the year and pay your Tier 1 and 2 cost-share and total cost of your tier 3, 4, and 5 drugs until you reach your $275 deductible.
Initial Coverage Phase
You begin this phase when you fill your first prescription after your deductible phase and pay the the cost-shares noted above for covered drugs until your total yearly drug costs (what you pay PLUS what the plan pays) reach $4,130.
IMPORTANT NOTE ABOUT PRESCRIPTION PRICING: In some cases, the cost of a drug is lower than the copay amount of its tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.
Coverage Gap Stage*
After your total yearly drug costs (what you pay PLUS what the plan pays) reach $4,130, you will pay 25% of the price for brand name drugs (plus a portion of the dispensing fee) and pay 25% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $6,350.
Catastrophic Coverage Stage*
After your yearly out-of-pocket drug costs reach $6,550 you pay:
For generics (including brand-name drugs treated as generic): The greater of $3.70 or a 5% coinsurance.
For all other drugs, the greater of $9.20 or a 5% coinsurance.
*Different cost-sharing applies for Members who receive "Extra Help" (Low-Income Subsidy (LIS/LICS))
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:
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)
If you are not sure whether your expense is eligible for reimbursement, please call Martin's Point Generations Advantage Member Services at 1-866-544-7504 or see the Wellness Wallet FAQs for details.
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:
Call Amplifon, 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.
For more information, call LifeStation at: 1-866-220-0934
Talk to your doctor about which screening is right for you—all have a $0 copay when you go to an In-network provider.
Screening Test |
How Often6 | 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 Sigmoidoscopy6 OR Screening Barium Enema |
Every four years | At facility |
Colonoscopy6 Screening | Every 10 years | At facility |
Members receive a quarterly amount to purchase from over 300 CVS brand, over-the-counter products, including:
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:
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:
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.