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Prime (HMO-POS)

Generations Advantage Prime (HMO-POS) offers comprehensive medical coverage, plus prescription drug coverage. You can use in-network providers and pay low copayments for services, but 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/$54 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, Cumberland, Kennebec, Sagadahoc and York counties.

    The $54 monthly plan premium for Prime (HMO-POS) Plan is for Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties in Maine, and Hillsborough and Strafford counties in New Hampshire.

  • $0 annual routine physical and routine vision exam.1
  • $5 copays for primary care office visits.
  • No copays for a range of preventive services.
  • $35 copays for specialist visits.
  • $3,200/$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 (drug list) to see if our drugs are covered. 
  • $0 copays for many generics at Hannaford Pharmacies.3
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  • Coverage for emergency care worldwide
  • Urgent care coverage nationwide.
  • Now with preventive dental in 2014.  Read more.  
  • 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

1In-network, you pay $0 for a routine physical, once per year, and $0 for an annual routine eye exam.

2The $3,200 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. 

3Limitations, copays, and restrictions may apply. At preferred pharmacies, you pay $0 for Tier 1 (preferred generic) drugs. Other pharmacies 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, 2015. Martin's Point Generations, LLC, is a Medicare Advantage organization with a Medicare contract.

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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. 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.  

Prime (HMO-POS) Plan Documents and Resources

Annual Notice of Changes - Androscoggin, Cumberland, Kennebec, Sagadahoc and York Counties

Annual Notice of Changes - All Other Maine Counties

Annual Notice of Changes - Hillsborough and Strafford Counites, NH

Evidence of Coverage Document - Androscoggin, Cumberland, Kennebec, Sagadahoc and York Counties

Evidence of Coverage Document - All Other Maine Counties

Evidence of Coverage Document - Hillsborough and Strafford Counties, NH

Summary of Benefits  

Provider and Pharmacy Directory - Maine

Provider and Pharmacy Directory - New Hampshire

2014 Abridged Formulary 

2014 Prime Comprehensive Formulary 

2014 Plan Ratings 

Reimbursement Form - Wigs, Transplant Transportation and Preventive Dental

Reimbursement Form _ Standard

Caremark Standard Reimbursement Form

Multi-language Interpreter Services

 

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Prescription Search

Our Prime (HMO-POS) and Select (PPO) plans offer comprehensive prescription drug coverage. Find out which cost-sharing tier your prescriptions are in. Learn more

Find a Delta Dental Dentist

Our Prime (HMO-POS) plan offers preventive dental coverage. Find a Delta Dental dentist. Learn more