2022 Prime (HMO-POS) Plan

Generations Advantage Prime (HMO-POS) offers complete medical, hospital, and Part D Prescription Drug coverage. You can use in-network doctors and health service providers and pay low copayments for medical services. You also have the flexibility to go outside the network for certain designated services with the Point-of-Service (POS) benefit. It is available throughout Maine and New Hampshire.


Your Area

Prime Benefits

Costs

  • Please enter your Zip Code above to see your plan premium.

*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.

Features

  • Part D prescription drug coverage with no deductibles (see if your drugs are covered)
  • Worldwide urgent and emergency care
  • Large network of doctors across Maine and New Hampshire (see if your doctor is in-network)
  • Out-of-network flexibility: option of getting many services outside of network with the Point-of- Service benefit (you may pay more for out-of-network services)
  • Over-the-counter (OTC): Up to $50 quarterly for members to purchase select CVS-brand, over-the-counter items
  • Wellness Wallet: Up to $400 reimbursed each year in total for eyewear, face masks, fitness benefit, naturopathic services, acupuncture, nutritional/dietary education, and weight management programs (see what's covered)
  • Hearing aids: $495/$695/$1,095/$1,495/$2,095 copay per ear, depending on tier selected (no copays for fittings or evaluations)
  • Flu shot benefit: Get your annual flu shot at no cost, either at your primary care provider’s office (who may charge an office visit copay) or a participating pharmacy.2,3

Comprehensive Dental Benefits

  • No waiting periods for coverage
  • $50 office visit copay
  • $1,000 benefit maximum
  • See a dentist in the Delta Dental network.
  • Diagnostic and preventive services are fully covered with no coinsurance or deductible (includes cleaning, exams, and X-rays).
  • Basic restorative services are covered with 50% coinsurance and a one-time $50 deductible (includes fillings, oral surgery, root canals, and periodontal maintenance).
  • Major restorative services are covered with 50% coinsurance and a one-time $50 deductible (includes dentures, bridges, crowns, onlays, and implants).

 

Part D Prescription Drug Copayments

Tier 1 2 3 4 5
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* $0 $10 $40 $95 33% of cost
Pharmacies with standard cost sharing, 30-day supply* $4 $18 $47 $100 33% of cost
Mail-order, 90-day supply $10 $45 $117.50 $250 33% of cost

*For 90-day supply cost, multiply by three.


What makes a 5 Star Medicare Plan?

Martin's Point has plans that have received the highest possible ratings from the government agency that administers Medicare. Our quality and performance across healthcare and customer experience are top-notch!

Medicare Pre-Enroll Guide Image

Open Enrollment Begins October 15

Request your 2022 Medicare Guide to learn more about our plans and discover how a Generations Advantage plan can help you live your best life.

1At pharmacies with preferred cost-sharing, you pay $0 for Cost-Sharing Tier 1 (preferred generic drugs and certain preferred brand name drugs). Other pharmacies are available in our network.
2Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Prime and costs do not count toward your Part D drug spend or out-of-pocket costs. 
3The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.

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