Martin’s Point Generations Advantage Alliance (HMO)
H5591 - 003 - 0
(5 / 5)
Martin’s Point Generations Advantage Alliance (HMO) is a Medicare Advantage (Part C) Plan by Martin’s Point Generations Advantage.
This page features plan details for 2023 Martin’s Point Generations Advantage Alliance (HMO) H5591 – 003 – 0 available in All Maine & NH Counties.
IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:
Locations
Martin’s Point Generations Advantage Alliance (HMO) is offered in the following locations.
Plan Overview
Martin’s Point Generations Advantage Alliance (HMO) offers the following coverage and cost-sharing.
| Insurer: | Martin’s Point Generations Advantage |
| Health Plan Deductible: | $0.00 |
| MOOP: | $5,000 In-network |
| Drugs Covered: | No |
Ready to sign up for Martin’s Point Generations Advantage Alliance (HMO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Martin’s Point Generations Advantage Alliance (HMO) qualifies for a monthly Medicare Give Back Benefit of $50.00.
| Premium Reduction: | $50.00 |
Premium Breakdown
Martin’s Point Generations Advantage Alliance (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $164.90 | $0.00 | $50.00 | $114.90 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Martin’s Point Generations Advantage Alliance (HMO) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: Yes, contact plan for further details |
Dental (comprehensive)
| Diagnostic services: | 20% coinsurance (limits may apply) (authorization required) (referral required) |
| Endodontics: | 20% coinsurance (limits may apply) (authorization required) (referral required) |
| Extractions: | 20% coinsurance (limits may apply) (authorization required) (referral required) |
| Non-routine services: | 20% coinsurance (limits may apply) (authorization required) (referral required) |
| Periodontics: | 20% coinsurance (limits may apply) (authorization required) (referral required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | 50% coinsurance (limits may apply) (authorization required) (referral required) |
| Restorative services: | 50% coinsurance (limits may apply) (authorization required) (referral required) |
Dental (preventive)
| Cleaning: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | Not covered (no limits) |
| Oral exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | 20% coinsurance (authorization required) (referral required) |
| Diagnostic tests and procedures: | 0-5% coinsurance (authorization required) (referral required) |
| Lab services: | $0-5 copay or 0-20% coinsurance (authorization required) (referral required) |
| Outpatient x-rays: | 5% coinsurance (authorization required) (referral required) |
Doctor visits
| Primary: | $0 copay |
| Specialist: | $5 copay per visit (authorization not required) (referral required) |
Emergency care/Urgent care
| Emergency: | $110 copay per visit (always covered) |
| Urgent care: | $0 copay |
Foot care (podiatry services)
| Foot exams and treatment: | $5 copay (authorization not required) (referral required) |
| Routine foot care: | Not covered |
Ground ambulance
| $325 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Hearing aids: | $295-1,895 copay (limits may apply) (authorization not required) (referral not required) |
| Hearing exam: | $5 copay (authorization not required) (referral required) |
Hospital coverage (inpatient)
| $375 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
Hospital coverage (outpatient)
| $0-275 copay per visit (authorization required) (referral not required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $5,000 In-network |
Medical equipment/supplies
| Diabetes supplies: | $0 copay (authorization not required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 10% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | 10% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 20% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | $220 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) (referral not required) |
| Outpatient group therapy visit: | $0 copay (authorization required) (referral not required) |
| Outpatient group therapy visit with a psychiatrist: | $0 copay (authorization required) (referral not required) |
| Outpatient individual therapy visit: | $0 copay (authorization required) (referral not required) |
| Outpatient individual therapy visit with a psychiatrist: | $0 copay (authorization required) (referral not required) |
Optional supplemental benefits
| No |
Preventive care
| $0 copay (authorization not required) (referral not required) |
Rehabilitation services
| Occupational therapy visit: | $0 copay (authorization not required) (referral required) |
| Physical therapy and speech and language therapy visit: | $0 copay (authorization not required) (referral required) |
Skilled Nursing Facility
| $10 per day for days 1 through 20 $196 per day for days 21 through 100 (authorization required) (referral not required) |
Transportation
| Not covered |
Vision
| Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Other: | Not covered (no limits) |
| Routine eye exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Upgrades: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Wellness programs (e.g., fitness, nursing hotline)
| Covered (authorization not required) (referral not required) |
Ready to sign up for Martin’s Point Generations Advantage Alliance (HMO) ?