At a glance
- Martin’s Point is a not-for-profit organization that began offering Medicare Advantage (Part C) plans in 2007.
- The organization offers many different types of Medicare Advantage plans.
- Plans are available to residents throughout Maine and New Hampshire.
Martin’s Point Generations Advantage is a Medicare Part C plan that offers a variety of Medicare services in packages tailored for your needs and budget. Like all Medicare Advantage plans, Martin’s Point plans are optional.
Martin’s Point Health Care is a not-for-profit healthcare company that provides both direct patient care, as well as healthcare plans. The organization has several Medicare Advantage plans available to people who are eligible for Medicare and live within their service area.
Read on to discover information about the Martin’s Point’s Medicare Advantage plans.
Martin’s Point offers many types of Medicare Advantage plans, which we’ll discuss in detail next.
Martin’s Point HMO plans
Health Maintenance Organization (HMO) plans provide healthcare via facilities and networks of approved network healthcare providers. Medicare services provided outside this network are generally not covered except when specified.
Martin’s Point PPO plans
Preferred Provider Organization (PPO) plans allow you to use reduced cost medical services from a network of approved providers and to seek care from out-of-network providers at an increased cost. Martin’s point offers both regional PPO (RPPO) and local PPO (LPPO) options.
Martin’s Point SNPs
are healthcare plans (HMO or PPO) designed specifically for individuals with certain medical conditions. These plans were created to help people with chronic health conditions access services and coordinate their care.
Martin’s Point Health Care offers six different Medicare Advantage plans under its Martin’s Point Generations Advantage program. If you live in Maine or New Hampshire, you can find Martin Point Health Care plans available in your area by using Medicare’s plan finder tool.
Generations Advantage Prime (HMO-POS)
This plan is an HMO Point-of-Service (HMO-POS) plan that offers medical, hospital, and prescription coverage. In-network care is included with low copayments, but the POS program also allows you to use out-of-network providers for certain services. It’s available throughout Maine and New Hampshire.
Generations Advantage Flex (RPPO)
This plan covers physician and hospital services as well as prescription medications. It was created to offer increased flexibility, allowing out-of-network coverage at an additional cost. It is available throughout Maine and New Hampshire.
Generations Advantage Select (LPPO)
This is another plan focused on flexibility with increased coverage for out-of-network services. The plan covers physician and hospital services, as well as prescription medications. Unlike the Flex plan, this plan does not include dental coverage. It is available throughout Maine and New Hampshire.
Generations Advantage Value (HMO)
This HMO plan covers physician and hospital services with supplemental coverage but does not contain a prescription plan. You are required under this plan to use in-network providers for all services except urgent and emergency care. It is available throughout Maine and New Hampshire.
Generations Advantage Value Plus (HMO)
This HMO plan covers physician and hospital services plus prescription drugs. You are required under this plan to use in-network providers for all services except urgent and emergency care. It is available throughout Maine except for in Cumberland county, and only in Hillsborough and Strafford counties in New Hampshire.
Generations Advantage Focus DC (HMO SNP)
This HMO SNP covers physician and hospital services plus prescriptions for Cumberland County residents in Maine who have been diagnosed with diabetes. You are required under this plan to use in-network providers for all services except urgent and emergency care.
Like most Medicare Advantage plans, specific options for coverage under Martin’s Point Generations Advantage plans varies by location.
Martin’s Point offers several different Medicare Advantage plans, but each plan features a core set of services.
Every Martin’s Point Generations Advantage plan includes the following coverage:
- physician and hospital visits
- $0 in-network preventive screenings/care
- no deductibles for medical/hospital visits
- annual free flu shots
- $0 once annual in-network physical exam and wellness visit
- annual out-of-pocket maximum
- urgent care nationwide
- emergency care worldwide
- routine vision exams
- hearing aids and batteries
- over-the-counter items
In addition to these benefits, Martin’s Point plans also offer “Wellness Wallet” reimbursements for things like:
- face masks
- glasses and contact lenses
- nutrition, dietary, and weight management
- fitness services and equipment
- acupuncture and naturopathic services
Part D coverage
Five of the Martin’s Point Generations Advantage plans offer Medicare Part D prescription drug coverage. These are:
- Generations Advantage Prime (HMO POS) 2021
- Generations Advantage Flex (RPPO) 2021
- Generations Advantage Select (LPPO) 2021
- Generations Advantage Value Plus (HMO)
- Generations Advantage Focus DC (HMO SNP) 2021
Prescription plans in the program offer prescriptions with no deductible or a $275 deductible for medications in tiers 3 to 5 of the formulary. There are different limits for copayments on generic and brand name medications at certain pharmacies or through a mail-order program.
Depending on the plan you choose, Medicare Advantage plans like Martin’s Choice will cost you a monthly premium, plus deductibles, coinsurances, and copayments.
For most Martin’s Point plans, premiums are free or under $100 per month. Most plans have no deductibles except for prescriptions — and they limit copayments to specialty services or out-of-network providers.
Martin’s Point plans are available to residents in Maine and New Hampshire, with services limited in some counties. Here are examples of what the Martin’s Point plans will cost in various cities.
|Prime (HMO POS) 2021||Flex (RPPO) 2021|| Select (LPPO) |
| Alliance (HMO) |
|Value Plus (HMO)|
|Focus DC (HMO SNP) 2021|
|Premiums||based on your county||$53||$99||based on your county; $60 Part B reduction||no premium besides Part B||no premium besides Part B|
|Deductible for hospital or doctor visits||no||no||no||no||no||no|
|Primary care copay||$0 in network, |
$35 out of network
|$0 in network,|
$30 out of network
|$20 in network,|
30% out of network
|$0 in network only||$10 in network only||$0 |
in network only
|Specialist copay||$40 in network, $55 out of network||$50 in network, 30% out of network||$40 in network, 30% out of network||$5 in network,|
no coverage out of network
|$50 in network,|
no coverage out of network
|Part D deductible||no||$275 for tiers 3–5 drugs only||no||—||$275 for tiers 3–5 medications||no|
(not including premiums and Rx copays)
|$6,850 in network and out of network||$5,500 for in-network services/ $8,000 combined in and out of network||$7,300 for in-network services/ $10,000 combined in and out of network||$5,000 in network only||$7,550 in network only||$5,700 |
in network only
Medicare Part C, or Medicare Advantage, plans combine multiple Medicare elements into a single package. Typically, Medicare beneficiaries have a Medicare Part A plan for inpatient needs and a Medicare Part B plan for outpatient needs. Prescription and supplemental plans are optional.
While Medicare parts A and B can be provided directly by Medicare, Medicare Part D’s prescription plans are offered through private plans. Medicare Advantage is a hybrid Medicare product offered by private plans. It combines Medicare parts A and B, plus other elements like prescription coverage, dental, vision, and more.
- Martin’s Point is a not-for-profit healthcare organization that offers direct patient care and Medicare Advantage health plans in New Hampshire and Maine.
- Services and costs vary by county.
- You can choose a plan based on your needs and your budget.
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