Martin's Point Generations Advantage Flex (Regional PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Martin's Point Generations Advantage
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
No Rating
out of 5 stars

State: New Hampshire

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$19
$0
$19
$0
$8,000 In and Out-of-network
$5,500 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: 30% per visit
In-network: $45 per visit
Out-of-network: 30% per visit

Tests, labs, & imaging

In-network: 20%
Out-of-network: 20%
In-network: $0-5 or 0-20%
Out-of-network: 20%
In-network: 20%
Out-of-network: 30%
In-network: $12
Out-of-network: 30%
$90 per visit (always covered)
$45 per visit (always covered)

Hospital Services

In-network: $325 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 30% per stay
In-network: $0-350 per visit
Out-of-network: 30% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 30% per stay

Preventive services

In-network: $0 copay
Out-of-network: 30%

Ambulance

In-network: $295
Out-of-network: $295

Therapy services

In-network: $40
Out-of-network: 30%
In-network: $40
Out-of-network: 30%

Mental health services

In-network: $10
Out-of-network: 30%
In-network: $10
Out-of-network: 30%
In-network: $10
Out-of-network: 30%
In-network: $10
Out-of-network: 30%

Opioid treatment services

Not covered

Other services

In-network: 20% per item
Out-of-network: 30% per item
In-network: 20% per item
Out-of-network: 30% per item
In-network: 20% per item
Out-of-network: 20% per item

Prescription Drug Benefits

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 :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

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

Part B Drugs

In-network: 20%
Out-of-network: 20%
In-network: 20%
Out-of-network: 20%

Extra Benefits

Hearing

In-network: $45
Out-of-network: 30%
In-network: $0 copay
Out-of-network: 30%
In-network: $595-895
Out-of-network: $595-895

Preventive Dental

Covered under office visit
Covered under office visit
Not covered
Covered under office visit

Comprehensive dental

In-network: $50 or 50%
Out-of-network: $50 or 50-75%
In-network: $50 or 50%
Out-of-network: $50 or 50-75%
In-network: $50 or 50%
Out-of-network: $50 or 50-75%
In-network: $50 or 50%
Out-of-network: $50 or 50-75%
In-network: $50 or 50%
Out-of-network: $50 or 50-75%
In-network: $50 or 50%
Out-of-network: $50 or 50-75%
In-network: $50 or 50%
Out-of-network: $50 or 50-75%

Vision

In-network: $0 copay
Out-of-network: 30%
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating

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