Select (PPO) Plan

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Generations Advantage Select (PPO) is designed for those looking for a health care plan with more flexibility. With this plan, you get complete medical, hospital, and Part D Prescription Drug coverage and you can see out-of-network doctors for all covered medical services, though you pay less for in-network doctors.

  • PPO – This plan has a Preferred Provider Organization which means you will pay less for services received by a preferred network of doctors, but you have the option to choose out-of-network providers, as well. 
  • Low monthly premium (remember, you must continue to pay your Medicare Part B premium)
  • No Deductible
  • $0 annual routine physical and annual routine vision exam (in-network)
  • Office visit copays: $20 primary care in-network ($25 out-of-network)
  • $0 copays for a range of preventive services when you see an in-network provider
  • $40 copays for specialist visits (30% out-of-network)
  • No deductibles for prescription drugs. Search our Formulary (drug list) to see if your drugs are covered.
  • $0 copays for many generics at Hannaford Pharmacies1
  • Out-of-pocket maximum for medical services: $6,700/$6,0002 combined in and out-of-network. Your plan premium and prescription drug copayments don't count toward this maximum.
  • Emergency care coverage worldwide
  • Urgent care coverage nationwide
  • A large network of local doctors to choose from in our provider network. Since the Select (PPO) plan is a PPO plan, you have the option of getting all services outside the network, but you will generally pay more for these services.3 
  • Wellness Wallet: The plan will reimburse members for certain services not covered by Original Medicare. Members may select from the following benefits, not to exceed $150 annually in total: Fitness Benefit, Naturopathic Services, and Acupuncture .

Looking for plan documents? Click here to go to the member resource page.

Drug Copays

*For 90-day supply multiply 30-day supply amount by three

Flu Shot Benefit

Getting a Flu Shot? Know before you go!

Here are some pointers to help you know what to expect when you go for your flu shot this season.

As a Generations Advantage Select plan member, you have two ways to get your annual flu shot at no cost:

1. 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.)

2. Get the shot at a pharmacy that is participating in our “Vaccine Pharmacy Network.”4

Which pharmacies are participating in the Vaccine Pharmacy Network?

Some participating pharmacy chains include:

  • Hannaford
  • Rite Aid
  • CVS (including former Target pharmacies)
  • Shaw’s/Osco
  • Walgreens
  • Walmart

Other pharmacies are also participating, including several independent pharmacies. If you do not see your pharmacy listed above, please call Member Services.

What seasonal flu vaccines are covered5 through the Vaccine Pharmacy Network?

This season your Generations Advantage plan covers most flu vaccines!

This includes:

  • Quadrivalent
  • Trivalent
  • Trivalent (high dose) 
  • Intradermal

What if you go to a pharmacy that does not participate in the Vaccine Pharmacy Network?

If you get your flu shot at a pharmacy that is not in the Vaccine Pharmacy Network, it may still be covered by your Generations Advantage Select plan. You will have to pay the full cost up front at the pharmacy and submit a form to us for reimbursement. The Reimbursement Form is on the Plan Documents page. You can also call Member Services to request a paper copy of this form.

What if you receive your flu shot at a pharmacy and don’t show your member ID card?

If you don’t show your Generations Advantage member ID card when you get your flu shot, you’ll have to pay the full cost up front at the pharmacy. You can then submit a form to us for reimbursement. The Reimbursement Form is on the Plan Documents page. You can also call Member Services to request a paper copy of this form.

What if your pharmacist has questions or trouble sending your flu shot claim?

If your pharmacist has problems sending your claim to us, he or she should call 1-800-364-6331 for help.

What should you do if you have questions related to your flu shot, the Vaccine Pharmacy Network, or if your pharmacy isn’t listed?

If you have questions about the flu shot, or any other benefit, please call Member Services.

Thank you for taking care of yourself by getting this important vaccination.

 

1Limitations, copays, and restrictions may apply. At 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.

2Select Plan maximum out-of-pocket: $6,000 in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, and York counties; $6,700 in Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, and Washington counties in Maine, and Hillsborough, and Strafford counties in New Hampshire.

3Out-of-network/non-contracted providers are under no obligation to treat Select plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

4The 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.

5Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Select and costs do not count toward your Part D drug spend or out-of-pocket costs. Limitations, copayments, and restrictions may apply. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan. Limitations, restrictions, and copays may apply. Benefits, formulary, pharmacy network, premium and/or copays/coinsurance may change on January 1 of each year. Martin's Point Generations Advantage is a health plan with a Medicare contract offering HMO-POS, PPO, HMO, and HMO SNP products. Enrollment in a Martin's Point Generations Advantage plan depends on contract renewal.

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The materials on this page may be made available in other formats such as Braille, large print or other alternate formats. Please contact us for more information. Call Member Services at 1-866-544-7504 (TTY: 711). We are available 8 am - 8 pm, seven days a week from October 1 - February 14, and Monday through Friday the rest of the year. Calls to this number are free.