Martin's Point Generations Advantage Prime (HMO-POS)
Available to residents of Cumberland County, ME for 2026. Contract H5591, plan 006, segment 1.
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Plan details
| Monthly premium (Part C + D) | $38.00 |
|---|---|
| — medical (Part C) part | $8.20 |
| — drug (Part D) part | $29.80? |
| Monthly premium with full Extra Help (LIS) | $16.30?drug (Part D) part $8.10; Extra Help does not cover the medical (Part C) premium |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $7,000.00? |
| In- and out-of-network out-of-pocket maximum | $7,000.00 |
| Drug deductible | $300.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS? |
| Contract / plan | H5591-006-1 |
| Offered by | Martin's Point Generations Advantage |
| Parent organization | Martin's Point Health Care, Inc. |
| Formulary drugs | 3,507 |
| Formulary exception tier | 4? |
| Pharmacy search | MartinsPoint.org/Advantage |
| Member services | (888)618-2049TTY 711 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H5591 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $40 copay(referral required) |
| Other health care professional | $0–$40 copay |
| Additional telehealth services | $0–$40 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay(authorization required) |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 0%–15% coinsurance(authorization and referral required) |
| Lab services | $0–$5 copay; 0%–20% coinsurance(authorization and referral required) |
| Diagnostic radiology (e.g. MRI, CT) | 15% coinsurance(authorization and referral required) |
| Therapeutic radiology | 15% coinsurance(authorization and referral required) |
| Outpatient x-rays | $25 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $30 copay |
| Worldwide emergency coverage | $115 copay · $25,000 plan limit |
| Worldwide urgent care | $115 copay · $25,000 plan limit |
| Worldwide emergency transportation | $325 copay |
| Hospital care | |
| Inpatient hospital stay | $350 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient hospital services | $0–$300 copay(authorization required) |
| Outpatient observation | $300 copay(authorization required) |
| Ambulatory surgical center | $250 copay(authorization required) |
| Outpatient blood services | $0 copay(authorization and referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $150 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance(authorization required) |
| Rehabilitation | |
| Occupational therapy | $30 copay(referral required) |
| Physical therapy and speech-language therapy | $30 copay(referral required) |
| Cardiac rehabilitation | $0 copay(authorization required) |
| Pulmonary rehabilitation | $0 copay(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $275 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient mental health, individual session | $25 copay(authorization required) |
| Outpatient mental health, group session | $10 copay(authorization required) |
| Psychiatrist, individual session | $25 copay(authorization required) |
| Psychiatrist, group session | $10 copay(authorization required) |
| Partial hospitalization | $75 copay(authorization required) |
| Intensive outpatient program | $75 copay |
| Outpatient substance use, individual session | $25 copay(authorization required) |
| Outpatient substance use, group session | $10 copay(authorization required) |
| Opioid treatment program | $0 copay(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $325 copay(authorization required) |
| Air ambulance | $325 copay(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay |
| Diabetic therapeutic shoes or inserts | $0 copay |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay |
| Routine chiropractic care | Not covered |
| Acupuncture | $0 copay |
| Foot exams and treatment (Medicare-covered) | $0–$40 copay(referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $40 copay(authorization required) |
| Preventive dental plan limit | $1,000 plan limit every year |
| Fluoride treatment | Not covered |
| Other diagnostic dental services | $50 copay; 50% coinsurance |
| Other preventive dental services | $50 copay; 50% coinsurance |
| Restorative services (fillings, crowns) | $50 copay; 50% coinsurance(authorization and referral required) |
| Endodontics (root canals) | $50 copay; 50% coinsurance(authorization and referral required) |
| Periodontics (gum disease) | $50 copay; 50% coinsurance(authorization and referral required) |
| Dentures and other removable prosthodontics | $50 copay; 50% coinsurance(authorization and referral required) |
| Maxillofacial prosthetics | $50 copay; 50% coinsurance(authorization and referral required) |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | $50 copay; 50% coinsurance(authorization and referral required) |
| Oral and maxillofacial surgery | $50 copay; 50% coinsurance(authorization and referral required) |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0–$40 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | 20% coinsurance(limits apply) |
| Eyewear plan limit | $150 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $40 copay(referral required) |
| Routine hearing exam | Not covered |
| Hearing aid fitting and evaluation | $0 copay(referral required, limits apply) |
| Hearing aid plan limit | $500 plan limit every year |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $50 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(limits apply) |
| Health education | Not covered |
| Nutritional / dietary benefit | $0 copay(limits apply) |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay(limits apply) |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | $0 copay(limits apply) |
| Weight management programs | $0 copay(limits apply) |
| Alternative therapies | $0 copay(limits apply) |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $5.00 |
| Tier 3 | 25% |
| Tier 4 | 30% |
| Tier 5 | 29% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $4.00 | $0.00 | $0.00 | $12.00 | $0.00 |
| Tier 2: Generic | $5.00 | $10.00 | $10.00 | $15.00 | $30.00 | $25.00 |
| Tier 6: Select Care Drugs | $0.00 | $4.00 | $0.00 | $0.00 | $12.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $4.00 | $0.00 | $0.00 | $12.00 | $0.00 |
| Tier 2: Generic | $5.00 | $10.00 | $10.00 | $15.00 | $30.00 | $25.00 |
| Tier 3: Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 30% | 32% | 32% | 30% | 32% | 32% |
| Tier 5: Specialty Tier | 29% | 29% | 29% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $4.00 | $0.00 | $0.00 | $12.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 1 other ME county
Benefits in plain text
Martin's Point Generations Advantage Prime (HMO-POS) (H5591-006-1) is a 2026 HMO-POS Medicare Advantage plan offered by Martin's Point Generations Advantage, available to residents of Cumberland County, ME.
The monthly premium is $38.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $16.30.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $7,000.00.
The combined in- and out-of-network out-of-pocket maximum is $7,000.00.
The drug deductible is $300.00. Tier 1, 2 and 6 exempt.
The plan's formulary lists 3,507 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $5.00; tier 3: 25%; tier 4: 30%; tier 5: 29%; tier 6: $0.00.
CMS gives the plan's contract (H5591) an overall rating of 4 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.