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2017 Medicare Advantage Plan Benefit Details for the Martin's Point Generations Advantage Select (PPO)

2017 Medicare Advantage Plan Details
Medicare Plan Name:Martin's Point Generations Advantage Select (PPO)
Location:Franklin, Maine
Plan ID:H1365 - 001 - 0     Click to see other plans
Member Services:1-866-544-7504 TTY users 711
— Enrollment Options —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Email a copy of the Martin's Point Generations Advantage Select (PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$89.00 (see Plan Premium Details below)
Annual Rx Deductible:$0
Annual Rx Initial Coverage Limit (ICL):$3,700
Health Plan Type:Local PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,000
Gap Coverage:No Gap Coverage
Total Number of Formulary Drugs:3,184 drugsBrowse the Martin's Point Generations Advantage Select (PPO) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:
Number of Drugs per
Plan's Pharmacy Search:http://www.martinspoint.org/medicare
Plan Offers Mail Order:Yes
Number of Members enrolled in this plan in Franklin, Maine:97 members
Number of Members enrolled in this plan in Maine:1,527 members
Number of Members enrolled in this plan (H1365 - 001):1,534 members
Plan’s Summary Star Rating: 4.50 out of 5 Stars.
Customer Service Rating: 4 out of 5 Stars.
Member Experience Rating: 5 out of 5 Stars.
Drug Cost Accuracy Rating: 5 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:Total
Part C
Part D Base
Part D Supplemental
Monthly Premium with Extra Help Low-Income Subsidy (LIS):100%
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
Total Monthly Premium with LIS (Parts C & D):$61.00$61.00$61.00$61.00
— Plan Health Benefits —
Health benefits and other data coming soon.

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