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/$75/$89 monthly premium. (Remember, you must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply.)
The $0 monthly plan premium for Prime (HMO-POS) Plan is for Androscoggin and Cumberland counties only.
The $29 plan premium is for Kennebec, Sagadahoc, and York counties.
The $75 monthly plan premium for Prime (HMO-POS) Plan is for Hillsborough and Strafford counties in New Hampshire.
The $89 monthly plan premium for Prime (HMO-POS) Plan is for Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties.
- $0 annual routine physical and routine eye exam.1
- $5 copays for primary care office visits.
- No copays for a range of preventive health care services.
- $35 copays for specialist doctor visits.
- $3,400/$4,000 out-of-pocket maximum2, 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. Check our Formulary, searchable list of medications and prescription drugs that are covered.
- $0 copays for many generics at Hannaford Pharmacies.3
- Coverage for emergency care worldwide
- Coverage for urgent care coverage nationwide.
- Plan includes preventive dental benefits.
- Available throughout the state of Maine and in Hillsborough and Strafford counties in New Hampshire
- Large network of doctors across Maine and New Hampshire.
- 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
1 In-network, you pay $0 for a routine physical exam, once per year, and $0 for an annual routine eye exam.
2 The $3,400 combined out-of-pocket maximum applies to all counties in Maine. The $4,000 combined out- of- pocket maximum applies to Hillsborough and Strafford counties, NH.
3 Limitations, copays, and restrictions may apply. At preferred pharmacies, you pay $0 for Tier 1 (preferred generic) drugs. Other pharmacies are available in our network.
4 There 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, LLC is a health plan with a Medicare contract offering HMO, HMO-POS, and PPO products. Enrollment in a Martin's Point Generations, LLC 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 Engagement at 1-866-544-7504 (TTY:711). Hours are 8 am to 8 pm, seven days a week from October 1 - February 14, and 8 am to 8 pm, Monday through Friday after February 14, and calls to these numbers are free.
All documents listed below were posted on 10/1/2014, there will be a date next to any document updated since 10/1/2014.
Prime (HMO-POS) Plan Documents and Resources
- Annual Notice of Changes - Androscoggin and Cumberland Counties
- Annual Notice of Changes - Kennebec, Sagadahoc and York Counties
- Annual Notice of Changes - Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington Counties
- Annual Notice of Changes - Hillsborough and Strafford Counties, NH
- Evidence of Coverage Document - All Maine Counties, and Hillsborough and Strafford Counties, NH
- Summary of Benefits - All Maine and New Hampshire Counties
- Provider and Pharmacy Directory - Maine
- Provider and Pharmacy Directory - New Hampshire
- 2015 Abridged Formulary
- 2015 Prime Comprehensive Formulary (updated 7/1/15)
- 2015 Plan Ratings (posted 10/15/14)
- Reimbursement Form - Standard
- Caremark Standard Reimbursement Form
- Multi-language Interpreter Services