2016 Prime (HMO-POS) Plan
Generations Advantage Prime (HMO-POS) offers complete medical and prescription drug coverage. You can use in-network doctors and health service providers and pay low copayments for medical services, and you also have the flexibility to go outside the network for certain services with the Point of Service (POS) benefit.
- HMO-POS – which means it’s an HMO with an out-of-network Point of Service (POS) option
- $0/$29/$891 monthly premium (remember, you must continue to pay your Medicare Part B premium)
- $0 annual routine physical and routine vision exam2
- $0 copays for primary care office visits
- No copays for a range of preventive services
- $35 copays for specialist visits
- $5,500 out-of-pocket maximum, 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.
- Part D Prescription Drug coverage with no deductibles
- $0 copays for many generics at Hannaford Pharmacies3
- Coverage for emergency care worldwide
- Urgent care coverage nationwide
- Available throughout the state of Maine and in Hillsborough and Strafford counties in New Hampshire
- Large network of doctors across Maine and New Hampshire
- Includes preventive dental services (Delta Dental PPO Network)
- Flexibility to see out-of-network providers for many services with the Point of Service benefit (you may pay more for out-of-network services)4
*For 90-day supply multiply 30-day supply amount by three
1You must continue to pay your Medicare Part B premium. The $0 plan premium for Prime Plan is for Androscoggin and Cumberland counties only. The $29 plan premium is for Kennebec, Sagadahoc and York counties. The Prime plan premium is $89 for Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington, and Strafford and Hillsborough counties in New Hampshire.
2In-network, you pay $0 for a routine physical, once per year, and $0 for an annual routine eye exam.
3Limitations, 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.
4There is a plan limit of $25,000 for Point of Service Benefits. Once you and the plan have paid $25,000 for POS benefits, you will be responsible for these costs if you continue to use out-of-network providers.
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, and PPO products. Enrollment in a Martin's Point Generations Advantage plan depends on contract renewal.
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All documents listed on this page were posted on 10/1/2015, there will be a date next to any document updated since 10/1/2015.