Martin s Point Generations Advantage Select (PPO)

H1365 - 001 - 0
4.5 out of 5 stars (4.5 / 5)

Martin s Point Generations Advantage Select (PPO) is a Medicare Advantage (Part C) Plan by Martin s Point Generations Advantage.

This page features plan details for 2024 Martin s Point Generations Advantage Select (PPO) H1365 – 001 – 0 available in Southern Maine & Southern New Hampshire.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Martin s Point Generations Advantage Select (PPO) is offered in the following locations.

Plan Overview

Martin s Point Generations Advantage Select (PPO) offers the following coverage and cost-sharing.

Insurer:Martin s Point Generations Advantage
Health Plan Deductible:$0.00
MOOP:$6,750 In and Out-of-network
$6,750 In-network
Drugs Covered:Yes
Please Note:
  • This plan does not charge an annual deductible for all drugs. The $275.00 annual deductible only applies to drugs on certain tiers.

Ready to sign up for Martin s Point Generations Advantage Select (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Martin s Point Generations Advantage Select (PPO) has a monthly premium of $99.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $62.70 $36.30 $0.00 $273.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Martin s Point Generations Advantage Select (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$275.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Enhanced Alternative
Additional Gap Coverage:Yes
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$36.30$

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $275.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Martin s Point Generations Advantage Select (PPO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,750 In and Out-of-network
$6,750 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network Yes, contact plan for further details

Outpatient hospital coverage

In-network $0-175 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network 30% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0-10 copay per visit (Not applicable.) (Not applicable.)
out-of-network Primary30% coinsurance per visit (Not applicable.) (Not applicable.)
In-network Specialist$40 copay per visit (Authorization is not required.) (Referral is required.)
out-of-network Specialist30% coinsurance per visit (Authorization is not required.) (Referral is required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$50 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures0-15% coinsurance (Authorization is required.) (Referral is required.)
out-of-network Diagnostic tests and procedures0-15% coinsurance (Authorization is required.) (Referral is required.)
In-network Lab services$0-5 copay or 0-20% coinsurance (Authorization is required.) (Referral is required.)
out-of-network Lab services$0-5 copay or 0-20% coinsurance (Authorization is required.) (Referral is required.)
In-network Diagnostic radiology services (e.g., MRI)20% coinsurance (Authorization is required.) (Referral is required.)
out-of-network Diagnostic radiology services (e.g., MRI)30% coinsurance (Authorization is required.) (Referral is required.)
In-network Outpatient x-rays15% coinsurance (Authorization is required.) (Referral is required.)
out-of-network Outpatient x-rays15% coinsurance (Authorization is required.) (Referral is required.)

Hearing

In-network Hearing exam$40 copay (Authorization is not required.) (Referral is required.)
out-of-network Hearing exam30% coinsurance (Authorization is not required.) (Referral is required.)
In-network Fitting/evaluation$0 copay (Limits may apply.) (Authorization is not required.) (Referral is required.)
out-of-network Fitting/evaluation$0 copay (Limits may apply.) (Authorization is not required.) (Referral is required.)
In-network Hearing aids$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Hearing aids$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

Oral examNot covered (There are no limits.) (Not applicable.) (Not applicable.)
CleaningNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Fluoride treatmentNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Dental x-ray(s)Not covered (There are no limits.) (Not applicable.) (Not applicable.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam30% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Rehabilitation services

In-network Occupational therapy visit$40 copay (Authorization is not required.) (Referral is required.)
out-of-network Occupational therapy visit30% coinsurance (Authorization is not required.) (Referral is required.)
In-network Physical therapy and speech and language therapy visit$40 copay (Authorization is not required.) (Referral is required.)
out-of-network Physical therapy and speech and language therapy visit30% coinsurance (Authorization is not required.) (Referral is required.)

Ground ambulance

In-network $325 copay (Not applicable.) (Not applicable.)
out-of-network $325 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$10-40 copay (Authorization is not required.) (Referral is required.)
out-of-network Foot exams and treatment30% coinsurance (Authorization is not required.) (Referral is required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay (Authorization is not required.) (Not applicable.)
out-of-network Diabetes supplies20% coinsurance per item (Authorization is not required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy20% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs20% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs20% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $340 per day for days 1 through 7
$0 per day for days 8 through 90 (Authorization is required.) (Referral is not required.)
out-of-network 40% per day for days 1 and beyond (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$220 per day for days 1 through 7
$0 per day for days 8 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric30% per day for days 1 and beyond (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$15 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$25 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$15 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$25 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)
out-of-network 30% per day for days 1 through 100 (Authorization is required.) (Referral is not required.)

Ready to sign up for Martin s Point Generations Advantage Select (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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