Generations Advantage

COVID-19 Coverage Information

Vaccines & Boosters: Make sure to bring your red, white, and blue Medicare card when you receive the vaccine or booster. Medicare will pay for all approved vaccines during the duration of the Public Health Emergency (PHE). If you get your vaccine/booster at a provider’s office, there may be an office visit copay. For information on the distribution and availability of the COVID-19 vaccine, please visit https://www.vaccines.gov/search/

Masks: KF94, KN95, and N95 masks reimbursable through Wellness Wallet. On January 14, 2022, the Centers for Disease Control and Prevention (CDC) recommended these masks to further limit the spread of COVID-19. Your Wellness Wallet reimburses for KF94 and KN95 masks purchased on 1/1/22 or later, and N95 masks purchased on 1/14/22 or later. Cloth masks and surgical masks are also reimbursable. For details, see the Wellness Wallet webpage.

Testing: Tests done at a test facility or doctor’s office are covered if they are medically necessary—this includes if you have COVID-19 symptoms or are symptom-free but have been exposed to someone with COVID-19. Travel- or work-related tests are not covered. Find a test site at your state’s health department website: Maine: https://www.maine.gov/covid19/testing OR New Hampshire: https://www.covid19.nh.gov/resources/testing-guidance.

Over-the-counter, at-home tests are currently not covered and not reimbursable through your Wellness Wallet. We will notify you of any coverage updates from the Centers for Medicare and Medicaid.

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: Following guidance from The Centers for Medicare and Medicaid Services (CMS), during the declared Public Health Emergency, all medical services normally covered by your plan at in-network levels will be covered with in-network member cost shares, even if you receive them from out-of-network providers. This applies to all Generations Advantage plans.

Once the Public Health Emergency has officially ended, network requirements will return and members receiving covered out-of-network medical 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 medical services received from out-of-network providers for an additional 30 days from the declaration of the end of the Public Health Emergency. If you need help finding an in-network provider, you can search the provider directory or contact Member Services at  1-866-544-7504.

As a reminder, once the declared public health emergency has ended, the following applies:

  • 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. 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. 

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

Have questions? We’re here to help.
Talk to a Member Service representative 8 am–8 pm, Monday-Friday.

Current Members:
1-866-544-7504

Enroll:
1-800-603-0652
(TTY: 711)