Member Rights

How to Appoint a Representative

You, your prescribing doctor or someone you name may ask us for a coverage determination. The person you name would be your appointed representative. You can name a relative, friend, advocate, doctor, or anyone else to act for you. Some other person(s) may already be authorized under State law to act for you. If you want someone to act for you, you and that person must sign and date a statement that gives that person legal permission to act as your appointed representative.

This statement must be sent to us at Martin's Point Generations Advantage, ATTN: Member Services, PO Box 9746 Portland, ME 04104-5040. If you have questions or need to learn how to name your appointed representative, you can call Member Services toll-free at 1-866-544-7504 (TTY: 711). We’re available 8 am–8 pm, seven days a week from October 1 to March 31; and Monday through Friday the rest of the year.

You also have the right to have an attorney ask for a coverage determination on your behalf. You can contact your own lawyer, or get the name of a lawyer from your local bar association or other referral service. There are also groups that will give you free legal services if you qualify.

Download an Appointment of Representation form from Medicare here

Rights and Responsibilities Upon Disenrollment

Since the Generations Advantage Prime (HMO-POS), Flex (RPPO), Select (LPPO), Value Plus (HMO), and Focus DC (HMO SNP) plans are Medicare Advantage plans with Part D prescription drug coverage your prescription coverage will end if you disenroll from one of these plans. If you disenroll, you should consider signing up for a new Medicare Advantage plan or Medicare Prescription Drug plan to ensure that you are covered for prescription drugs and avoid any "late enrollment penalty" that may apply. Your options include:

  • Enrolling in a different Medicare Advantage plan with Part D prescription drug coverage
  • Using Original Medicare for your medical needs, plus enrolling in a stand-alone Part D Medicare Prescription Drug plan.
  • If you do not choose one of these options, or obtain creditable prescription drug coverage elsewhere, you may have a late enrollment penalty if you decide to get Medicare prescription drug coverage at a later date.

Member Rights and Responsibilities Statement

A Note About Medigap Rights

If you will be changing to Original Medicare, you might have a special temporary right to buy a Medigap policy, also known as Medicare supplement insurance, even if you have health problems. For example, if you are age 65 or older and you enrolled in Medicare Part B within the past six months or if you move out of the service area, you may have this special right. Federal law requires the protections described above. Your state may have laws that provide more Medigap protections. According to the Maine Bureau of Insurance website, if you switch to original Medicare, your ability under Maine law to enroll in a Medicare Supplement plan depends on how long you were enrolled in Medicare Advantage. Recent Maine legislation extended the Medicare Advantage "trial period" from one year to three years.

If you have questions about Medigap or any special temporary rights you may have, you should contact your State Health Insurance Assistance Program, Maine SHIP. SHIP services are sponsored in Maine by the Office of Elder Services, Maine's Area Agencies on Aging and Legal Services for the Elderly, Inc. For help, call your local Area Agency on Aging at 877-353-3771 or Legal Services for the Elderly at 800-750-5353. They can provide information about Medigap policies in Maine. Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week, for more information about trial periods. TTY users should call 1-877-486-2024.

Value (HMO) Plan Members: If you disenroll from the Generations Advantage Value (HMO) plan, this will not affect any prescription drug coverage you may have.

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