Prime (HMO-POS) Plan 2020

Generations Advantage Prime (HMO-POS) offers complete medical, hospital, and Part D Prescription Drug coverage. You can use in-network doctors and health service providers and pay low copayments for medical services. You also have the flexibility to go outside the network for certain designated services with the Point of Service (POS) benefit. It is available throughout Maine and New Hampshire.

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Costs

  • Remember, you must continue to pay your Medicare Part B premium
  • No deductibles
  • $0 annual routine physical and annual routine vision exam (in-network)
  • $0 copays for primary care office visits
  • $0 copays for a range of preventive services
  • $40 copays for specialist visits
  • $0 copays for many generic drugs at Hannaford Pharmacies1

Features

  • Part D Prescription Drug coverage with no deductibles
    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
  • Includes comprehensive dental services (Delta Dental PPO Network)2
  • 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)
  • Wellness Wallet: The plan will reimburse up to $400 each year in total for eyewear, fitness benefit, naturopathic services, acupuncture, nutritional/dietary education, and weight management programs.
  • Hearing aid benefit
  • Over-the counter: The plan will cover up to $50 quarterly for members to purchase select CVS brand over-the-counter items

Peace of Mind

  • $6,500 out-of-pocket maximum for in- and out-of-network services, 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.

Plans Plan Tier Copays_0919_v0_1_OtherPlans

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

Comprehensive Dental

Click Prime Plan Comprehensive Dental benefit for more information. 

Flu Shot Benefit

Click Prime Plan Flu Shot benefit for more information.

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.

2Out-of-network/non-contracted providers are under no obligation to treat Prime plan members, except in emergency situations. For a decision about whether we will cover an out-ofnetwork 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 costsharing that applies to out-of-network services.

View Disclaimers

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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 to March 31, and Monday through Friday the rest of the year. Calls to this number are free.