Martin’s Point Generations Advantage Alliance (HMO)

H5591 - 003 - 0
5 out of 5 stars (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) ?

Get help from a licensed insurance agent.

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

8am – 11pm EST. 7 days a week

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
Please Note:
  • 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) ?

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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