Am I eligible to join Martin s Point Generations Advantage? When can I sign up for Martin s Point Generations Advantage?

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1 Martin s Point Generations Advantage Frequently Asked Questions Be sure to review the Medicare & You handbook from Medicare. If you haven t received it yet, you can visit and request a copy or read it online. Am I eligible to join Martin s Point Generations Advantage? You are eligible to join Generations Advantage if: a. You have both Medicare Parts A and B, or are getting them soon b. You are a resident in our service area, which includes all of Maine and Hillsborough and Strafford counties in New Hampshire c. You are currently not diagnosed with End-Stage Renal Disease (or receiving regular kidney dialysis) d. You have an election period. See the next question below for more details on election periods. When can I sign up for Martin s Point Generations Advantage? Typically, you may enroll in a Medicare Advantage plan like Martin s Point Generations Advantage only during the annual enrollment period from October 15 through December 7 of each year. There are exceptions that may allow you to enroll outside of this period, including when you: Are new to Medicare Have recently moved Are leaving employer or union coverage Have both Medicare and Medicaid or the state helps pay for your Medicare premiums Get (or no longer qualify for) extra help paying for Medicare prescription drug coverage Recently lost creditable prescription drug coverage Are moving into, live in, or have recently moved out of a Long-Term Care Facility Have had Medicare prior to now, but are now turning 65 There may be other election periods available to you. Please call us at (TTY: 711) if you have questions about these periods.

2 I am turning 65 in a few months. What happens? If you are already receiving Social Security retirement benefits, you will be contacted by Social Security a few months before you turn 65 and given the information you need about Medicare. If you are not receiving retirement benefits, you should contact Social Security about three months before your 65th birthday to sign up for Medicare. You can call them at (TTY: ), go to their website at or visit your local Social Security office. If you are still working, or covered by an employer or union plan, speak with your benefits administrator to learn what your options are. When you enroll in Medicare Parts A and B, you are enrolled in what is often called Original Medicare. Several other options offer additional coverage above what Original Medicare covers. Some of those options include Medicare Advantage plans, Part D prescription drug plans, or Medicare Supplement Policies. I have Medicare Part A but I m still on an employer plan. What happens when I retire? Many people stay on employer or union plans after they re eligible for Medicare. Once you know when you ll be leaving your employer plan, you ll want to call or visit your local Social Security office where you can enroll in Medicare Part B. To find your nearest Social Security office CLICK HERE. I m eligible for Medicare and thinking about retiring, but my spouse is not eligible for Medicare yet. What does he/she do? Spouses who are still working can get health care coverage from their employer plans. They cannot join any Medicare plan until they are eligible for Medicare. See questions 1 and 2 for eligibility information. Am I covered by Martin s Point Generations Advantage if I m a snowbird and go south for a few months in the winter? Yes, as long as you re still a resident here in Maine, or in Hillsborough and Strafford counties in New Hampshire. We have many members on our plans who spend a few months out of state. Coverage levels vary depending on which plan you choose. For

3 ALL of our plans, emergency care is covered worldwide and urgent care is covered nationwide. For care that is not urgent, our Prime (HMO-POS) plan includes a point of service benefit that allows members to receive some care outside of our network. Our Select (PPO) plan offers the flexibility of seeing any doctor or going to any hospital, anywhere, as long as they accept Medicare. You may pay more if you use an out-ofnetwork provider. What happens if I move out of state? We cover residents in the state of Maine and Hillsborough and Strafford counties in New Hampshire only, so if you permanently move out of those areas you need to notify the plan so you can disenroll and find a new plan in your new area. You have a Special Election Period from Medicare to join a new plan if you move. I am thinking of moving to Maine or Hillsborough or Strafford county in New Hampshire. When can I enroll? When you move to a new area Medicare gives you a Special Election Period to enroll in a plan like Generations Advantage. I am losing MaineCare or Medicaid benefits. Can I enroll? When you are eligible for (or losing) assistance from the state, you have a Special Election Period to enroll in a plan like Generations Advantage. I have End Stage Renal Disease. Can I enroll in a Medicare Advantage plan? People with End Stage Renal Disease should continue to use Original Medicare instead of joining a Medicare Advantage plan. I want to be able to choose to go to Mass. General in Boston for surgery. How does that work with your plans? Mass. General is not in the Generations Advantage network. However, the Select (PPO) plan offers the flexibility to choose to go out-of-network for planned inpatient hospital care. The Prime (HMO-POS) plan offers coverage for outpatient surgery out of network. For the Prime plan, you must get pre-authorization from the plan for

4 outpatient surgery whether you use in our out-of-network providers. You may pay more to go out of network. What s the difference between the Prime (HMO-POS) plan and the Select (PPO) plan? There are several differences between the plans. For example, the Prime (HMO-POS) plan your primary care doctor needs to be in our network, he or she would need to refer you to see a specialist, and you d need to get all planned inpatient hospital care done at in-network facilities. On the Select (PPO) plan, your primary care doctor can be in or out of the network, you would not need referrals for specialist visits, and you could choose to go out of the network for planned inpatient hospital care. Please refer to the Evidence of Coverage booklets to see a complete list of benefits and requirements for either plan. Can I purchase separate Medicare prescription drug coverage (Part D) and join your Value plan? Medicare does not allow you to be on the Value (HMO) plan and be part of a separate Medicare prescription drug (Part D) plan. Do I still need my Medicare Supplement (Medigap) plan once I enroll in a Medicare Advantage plan? No, you do not need a Medicare Supplement plan if you join a Medicare Advantage plan. I currently have Medicare prescription drug coverage (Part D) through another plan. Will my Medicare prescription drug coverage (Part D) under that plan be cancelled if I enroll in a Medicare Advantage plan? Yes. Medicare will automatically disenroll you from a Medicare prescription drug (Part D) plan if you enroll in one of our three plans. Our Prime (HMO-POS) and Select (PPO) plans include Part D prescription drug coverage. Our Value (HMO) plan does not.

5 Will you cancel my Medicare Supplement (Medigap) if I enroll? No, you would need to call the Medicare Supplement (Medigap) plan and cancel your coverage once you enroll in one of our plans. If you have other questions regarding Medicare, here are some numbers you can call: Martin s Point Generations Advantage (TTY: 711) Medicare Contacts Medicare: MEDICARE ( ) Social Security: (TTY/TDD: ) Maine State Health Insurance Assistance Program: (TTY/TDD: ) New Hampshire State Health Insurance Assistance Program (ServiceLink) (TTY/TDD: ) 24 hours a day, 7 days a week New Hampshire Medicaid: Maine Area Agencies on Aging MaineCare (Medicaid): (TTY: 711) Maine Low Cost Drugs for the Elderly and Disabled Program (DEL) and Maine Rx Plus: (TTY/TDD: )

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