Prime (HMO-POS) Plan 2017
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 planned services with the Point of Service (POS) benefit.
- HMO-POS – this is an HMO (in-network benefits) with an out-of-network Point of Service (POS) option
- Low monthly premium (remember, you must continue to pay your Medicare Part B premium)
- No Deductible
- $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
- $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 Pharmacies1
- Emergency care coverage worldwide
- Urgent care coverage nationwide
- Available throughout 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)2
- Wellness Wallet: The plan will reimburse members for certain services not covered by Original Medicare. Members may select from the following benefits, not to exceed $350 annually in total: Fitness Benefit, Naturopathic Services, and Acupuncture.
Looking for plan documents? Click here to go to the member resource page.
*For 90-day supply multiply 30-day supply amount by three
Generations Advantage Prime (HMO-POS) is happy to offer preventive dental coverage! These benefits are covered at a $40 copayment when seeing a Delta Dental PPO/Martin's Point Generations Advantage network dentist:
- Exam and routine cleaning (once in a 12-month period)
- Problem-focused exams as needed
- Bitewing X-rays (once in a 24-month period)
- X-rays of individual teeth as necessary
- Full-mouth/Panorex X-rays (once in a 5-year period)
- Surgical and routine extractions
- Emergency relief of pain
For more information, read the Dental Plan Overview and Benefits
To find a Northeast Delta Dental dentist use the link to the right.
Flu Shot Benefit
Getting a Flu Shot? Know before you go!
Here are some pointers to help you know what to expect when you go for your flu shot this season.
As a Generations Advantage Prime plan member, you have two ways to get your annual flu shot at no cost:
1. Get the shot at your Primary Care Provider’s office. (You may have to pay a copayment for the office visit, but there will be no cost for the flu shot.)
2. Get the shot at a pharmacy that is participating in our “Vaccine Pharmacy Network.”3
Which pharmacies are participating in the Vaccine Pharmacy Network?
Some participating pharmacy chains include:
- Rite Aid
- CVS (including former Target pharmacies)
Other pharmacies are also participating, including several independent pharmacies. If you do not see your pharmacy listed above, please call Member Services.
What seasonal flu vaccines are covered4 through the Vaccine Pharmacy Network?
This season your Generations Advantage plan covers most flu vaccines!
- Trivalent (high dose)
What if you go to a pharmacy that does not participate in the Vaccine Pharmacy Network?
If you get your flu shot at a pharmacy that is not in the Vaccine Pharmacy Network, it may still be covered by your Generations Advantage Prime plan. You will have to pay the full cost up front at the pharmacy and submit a form to us for reimbursement. The Reimbursement Form is on the Plan Documents page. You can also call Member Services to request a paper copy of this form.
What if you receive your flu shot at a pharmacy and don’t show your member ID card?
If you don’t show your Generations Advantage member ID card when you get your flu shot, you’ll have to pay the full cost up front at the pharmacy. You can then submit a form to us for reimbursement. The Reimbursement Form is on the Plan Documents page. You can also call Member Services to request a paper copy of this form.
What if your pharmacist has questions or trouble sending your flu shot claim?
If your pharmacist has problems sending your claim to us, he or she should call 1-800-364-6331 for help.
What should you do if you have questions related to your flu shot, the Vaccine Pharmacy Network, or if your pharmacy isn’t listed?
If you have questions about the flu shot, or any other benefit, please call Member Services.
Thank you for taking care of yourself by getting this important vaccination.
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.
2There 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.
3The Vaccine Pharmacy Network is offered through our relationship with our pharmacy benefit manager, CVS Caremark. Pharmacy network may change on January 1 of each year. Other pharmacies are available in our network.
4Influenza (flu) vaccines are covered under your Medicare Part B benefit through Generations Advantage Prime and costs do not count toward your Part D drug spend or out-of-pocket costs. Limitations, copayments, and restrictions may apply. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan.
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-POS, PPO, HMO, and HMO SNP 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 - February 14, and Monday through Friday the rest of the year. Calls to this number are free.