Flex (RPPO) Plan 2019

Generations Advantage Flex (RPPO) 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 and in-service-area doctors. It is available throughout the service area of Maine and New Hampshire.

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Costs

  • No medical deductible
  • $0 annual routine physical and annual routine vision exam (30% out-of-network)
  • Office visit copays: $5 primary care in-network and in-service-area (30% out-of-network and out-of-service-area)
  • $0 copays for a range of preventive services when you see an in-network provider
  • $45 copays for specialist visits (30% out-of-network)
  • $2 copays for many generics at Hannaford Pharmacies1

Features

  • Out-of-network flexibility
  • Part D Prescription Drug coverage with $295 deductible for Tiers 3-5
    Search our Formulary (drug list) to see if your drugs are covered 
  • Emergency care coverage worldwide
  • Urgent care coverage nationwide
  • Large network of doctors across Maine and New Hampshire
    Since the Flex (RPPO) 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.2
  • Wellness Wallet: The plan will reimburse up to $200 each year in total for dietary/nutrition, fitness benefit, naturopathic services, acupuncture, and weight management programs.

Peace of Mind

  • $6,700 out-of-pocket maximum ($10,000 combined in and out-of-network), which means a predictable limit on costs, even in the case of a serious health problem. Your plan premium and prescription drug copayments don't count toward this maximum.

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

Flex Plan Drug Copays Chart

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

Flu Shot Benefit

Click Flex plan Flu Shot benefit for more information. 

1Limitations, copays, and restrictions may apply. At pharmacies with preferred cost-sharing, you pay $2 for Cost-Sharing Tier 1
(preferred generic drugs and certain preferred brand name drugs). Other pharmacies are available in our network.

2Out-of-network/non-contracted providers are under no obligation to treat Flex 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.

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, HMO-POS, HMO SNP, Local and Regional PPO 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 - March 31, and Monday through Friday the rest of the year. Calls to this number are free.