Private insurance companies, such as Martin’s Point, offer Medicare Advantage plans. Maine and New Hampshire residents can opt for a five-star Martin’s Point Generations Advantage plan.
Medicare Advantage Part C plans offer an alternative form of healthcare coverage to original Medicare. These bundled plans combine the benefits of original Medicare and may also offer Part D prescription drug coverage.
This article discusses Martin’s Point Medicare Advantage plans and availability. It also looks at the costs, coverage, and benefits. Lastly, it provides an overview of Medicare plans.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Martin’s Point is a not-for-profit healthcare company that began in 1858. The company provides direct patient care and healthcare insurance plans.
Martin’s Point began offering the Generations Advantage plans to Maine residents in 2007, expanding to New Hampshire in 2013. These two states now have seven state-of-the-art healthcare facilities, providing both primary and specialty care.
Martin’s Point offers six different types of Medicare Advantage plans in New Hampshire and Maine. However, each plan’s availability may vary depending on a person’s county location.
Some plans have a 5-star, rating which is the highest available rating awarded by the government agency administering Medicare.
A person can enroll in the plans online, in person, or by telephone.
Coverage inclusions
All the company’s Advantage plans include coverage for:
- routine vision test
- worldwide emergency care
- nationwide urgent care
They also include an annual out-of-pocket maximum, zero deductible for in-network wellness visits and physical exams, and preventive care and screenings. They also have zero medical and hospital deductibles.
In addition, the company’s Advantage plans offer coverage for hearing aids and batteries and over-the-counter items. Furthermore, all the Advantage plans cover Wellness Wallet reimbursements.
The company’s Advantage plans include the following six health maintenance organization (HMO) and preferred provider organizer (PPO) plans.
Generations Advantage Alliance HMO
This HMO plan is available statewide in Maine and New Hampshire. It provides healthcare through a network of approved doctors, hospitals, and other providers. It does not include prescription drug coverage.
People must choose a primary care doctor who can refer them to specialists and coordinate their care. HMO plans do not provide cover if people use other healthcare providers outside the network, except in a medical emergency.
Generations Advantage Value Plus HMO
This plan is rated a 5-star plan, designed as a low-cost plan with prescription drug coverage.
Coverage is available in Strafford and Hillsborough counties in New Hampshire and across Maine except in Cumberland county.
Generations Advantage Prime HMO-POS
Available throughout Maine and New Hampshire, this HMO-POS plan allows people to use healthcare services either inside or outside the plan’s network for some services. However, there is a higher copay or coinsurance for using out-of-network providers.
Generations Advantage Prime includes prescription drug coverage.
Generations Advantage Flex (RPPO)
With PPO plans, a person can choose to use other services outside the network with higher out-of-pocket expenses. A person does not need to select a primary care doctor or request referrals to see a specialist.
The Generations Advantage Flex (RPPO) includes prescription drug coverage and comprehensive dental coverage. It is available to many people throughout Maine and New Hampshire. This online tool helps find providers.
Generations Advantage Select (LPPO)
Similar to the flexible RPPO plan, this plan offers healthcare services plus prescription medications across Maine and New Hampshire, depending on providers. However, the plan does not include dental cover.
Generations Advantage Focus HMO-SNP
SNPs are either HMO or PPO plans tailored specifically for people with particular diseases or characteristics. All parts of the plan, including provider choices, benefits, and drug formulary, is focused on meeting the specific needs of the target group they serve.
The Generations Advantage Focus DC 5-star plan provides healthcare services and prescription drug coverage, focusing on people with diabetes, with all benefits being in-network, except for emergency or urgent care. The plan is available to residents of Cumberland County in Maine.
Medicare Advantage plans, including those from Martin’s Choice, have a monthly premium, deductible, coinsurance, and copays. Some plans may have a zero deductible. A person must also pay a premium for Medicare Part B.
The following table shows some example costs for the six Martin’s Point Medicare Advantage plans.
| Alliance HMO | Value Plus HMO | Prime HMO-POS | Flex RPPO | Select LPPO | Focus HMO-SNP | |
|---|---|---|---|---|---|---|
| Wellness wallet | $350 annual maximum | $300 annual maximum | $400 annual maximum | $200 annual maximum | $200 annual maximum | $450 annual maximum |
| Part D copay | N/A | $0 – $250 | $0 – $250 | $0 – $237.50 | $0 – $250 | $0 – $250 |
| Part D deductible | N/A | Varies with medication | $0 | Varies with medication | $0 | $0 |
What about Part D coverage?
Martin’s Point includes Part D coverage in five Medicare Advantage plans. The exception is the company’s Generations Advantage Alliance HMO plan. There is no separate premium for the Part D prescription drug coverage.
The Value Plus, Select, and Focus DC plans do not have a deductible, which means a person pays only a copay or coinsurance. People may pay a different copay for generic and brand-name drugs at some pharmacies.
Medicare has four parts. These include original Medicare (Part A and Part B), Part C, also known as Medicare Advantage, and Part D.
Learn more about original Medicare here.
Medicare Part C
Medicare Advantage, Part C, plans provide an alternative to original Medicare. Medicare approves private companies to administer Part C plans and pays them to provide healthcare services.
Medicare Part C plans provide the same coverage as original Medicare and include doctor’s visits, laboratory and diagnostic tests, preventive health screenings, stays in the hospital, and emergency care.
Typically a person has to use the provider’s network; with original Medicare, a person can visit any Medicare-approved healthcare professional. Advantage plan benefits may include dental, vision, and hearing care.
Learn more about Medicare Advantage here.
Medicare Part D
Part C plans generally also cover prescription drugs. With original Medicare, Part D prescription drug coverage is an optional add on to help with the cost of medications.
The plans use a formulary that lists all the covered medications. People can use the government’s online tool to compare Part D costs and availability by location.
Martin’s Point offers six Medicare Advantage plans to people who live in New Hampshire and Maine. The availability of the plans varies by level of coverage and county.
The company’s Advantage plans include six health maintenance organization (HMO) and preferred provider organizer (PPO) plans.