Martin's Point Generations Advantage Value Plus (HMO-POS)

Maine Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Martin's Point Generations Advantage

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.5
out of 5 stars

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Plan Name
Martin's Point Generations Advantage Value Plus (HMO-POS)
Insurance Carrier
Martin's Point Generations Advantage
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Martin's Point Generations Advantage Value Plus (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Maine and offered by the health insurance company Martin's Point Generations Advantage. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$6,350
Primary doctor visit
$0-10 copay per visit
Specialist visit
$45 copay per visit
ER visit
$120 copay per visit (always covered)
Ambulance
$325 copay

Martin's Point Generations Advantage Value Plus (HMO-POS) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,350 In and Out-of-network $6,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Martin's Point Generations Advantage Value Plus (HMO-POS) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Martin's Point Generations Advantage Value Plus (HMO-POS) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Martin's Point Generations Advantage Value Plus (HMO-POS) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Martin's Point Generations Advantage Value Plus (HMO-POS) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Martin's Point Generations Advantage Value Plus (HMO-POS) received an overall government quality rating of 4.5 stars out of 5 stars.

Martin's Point Generations Advantage Value Plus (HMO-POS) performed better than Maine’s State average overall quality score of 4.0 stars.

This Plan’s 5-star Gov’t Quality Score
Maine State Average Score
Overall Government 5 Star Quality Rating
 4.5
 4.0
Summary rating of health plan quality
 4
 3.9
Staying healthy: screenings, tests, & vaccines
 4
 3.7
Managing chronic (long term) conditions
 4
 3.8
Member experience with health plan
 5
 3.7
Member complaints & changes in the health plan's performance
 4
 3.9
Health plan customer service
 4
 4.4
Summary rating of drug plan quality
 4.5
 3.9
Drug plan customer service
 4
 4.4
Member complaints & changes in the drug plan's performance
 4
 3.9
Member experience with the drug plan
 4
 3.7
Drug safety & accuracy of drug pricing
 4
 3.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Martin's Point Generations Advantage Value Plus (HMO-POS) received 4 stars for its health plan quality score which is better than the Maine State average health plan quality score of 3.9 stars.

Martin's Point Generations Advantage Value Plus (HMO-POS) received 4.5 stars for its drug plan quality score which is better than the Maine State average drug plan quality score of 3.9 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$6,350 In and Out-of-network
$6,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0-10 copay per visit
Out-of-network: $35 copay per visit
Specialist visit
In-network: $45 copay per visit
Out-of-network: $55 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: 0-15% coinsurance
Out-of-network: 0-15% coinsurance
Lab services
In-network: 0-20% coinsurance
Out-of-network: $0-5 copay or 0-20% coinsurance
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $15 copay
Out-of-network: 15% coinsurance
Emergency care
$120 copay per visit (always covered)
Urgent care
$50 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $360 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-network: 40% per day for days 1 and beyond
Outpatient hospital coverage
In-network: $0-275 copay per visit
Out-of-network: $400 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: No Data

Ambulance

Ground ambulance
In-network: $325 copay
Out-of-network: $325 copay

Therapy services

Occupational therapy visit
In-network: $40 copay
Out-of-network: $55 copay
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: $55 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $30 copay
Outpatient individual therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $30 copay
Outpatient group therapy visit
In-network: $25 copay
Out-of-network: $30 copay
Outpatient individual therapy visit
In-network: $25 copay
Out-of-network: $30 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$4.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$18.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier28%

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance

Hearing

Hearing exam
In-network: $45 copay
Out-of-network: $55 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: No Data
Hearing aids - All types
In-network: $0 copay
Out-of-network: No Data

Preventive Dental

Oral exam
Covered under office visit
Cleaning
Covered under office visit
Fluoride treatment
Not covered
Dental x-rays
Covered under office visit

Comprehensive dental

Non-routine services
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data
Diagnostic services
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data
Restorative services
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data
Endodontics
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data
Periodontics
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data
Extractions
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $50 copay or 50% coinsurance
Out-of-network: No Data

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: No Data
Contact lenses
In-network: $0 copay
Out-of-network: No Data
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: No Data
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: No Data
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: No Data
Upgrades
In-network: $0 copay
Out-of-network: No Data

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