In-network
Inpatient hospital
Days 1–5 $350 / day
Days 6–90 $0 / day
Total of listed copays · 5 charged days $1,750
● CMS 2026 plan record
Martin's Point Generations Advantage Prime (HMO-POS)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network$325 copay
Air · in-network$325 copay
Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group
Emergency services
Emergency room
$115 copay
Waived if admitted within 24 hours
Medical maximum
Maximum out-of-pocket
In-network$7,000
Combined in + out$7,000
Skilled care at home
Home health
In-networkCost share not reported
Out-of-networkNot separately reported
Monthly cost
Premium & giveback
Part C premium$109 / month
Consolidated C + D$109 / month
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Primary care physician
In: Verify in plan documents · Out: Not separately reported
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Specialist
In: $40 copay · Out: Not separately reported
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Preventive care
In: Cost share not reported · Out: Not separately reported
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Diagnostic procedures & tests
In: 0%–15% coinsurance · Out: Not separately reported
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Laboratory services
In: $0–$5 copay + 0%–20% coinsurance · Out: Not separately reported
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X-rays & standard imaging
In: 15% coinsurance · Out: Not separately reported
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MRI, CT & PET imaging
In: 15% coinsurance · Out: Not separately reported
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: $115 copay · Out: Not separately reported
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Ground ambulance
In: $325 copay · Out: Not separately reported
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Air ambulance
In: $325 copay · Out: Not separately reported
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Outpatient hospital
In: $0–$300 copay · Out: Not separately reported
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Outpatient surgery / ASC
In: $250 copay · Out: Not separately reported
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Home health
In: Cost share not reported · Out: Not separately reported
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: Cost share not reported · Out: Not separately reported
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Occupational therapy
In: $30 copay · Out: Not separately reported
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Physical & speech therapy
In: $30 copay · Out: Not separately reported
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Mental health services
In: $75 copay · Out: Not separately reported
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Substance use treatment
In: $75 copay · Out: Not separately reported
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Podiatry
In: $0–$40 copay · Out: Not separately reported
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Chiropractic
In: $15 copay · Out: Not separately reported
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Dental
In: $40 copay · Out: Not separately reported
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Vision
In: Cost share not reported · Out: Not separately reported
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Hearing
In: Cost share not reported · Out: Not separately reported
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Transportation
Not reported in this CMS export
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Fitness & wellness
In: Cost share not reported · Out: Not separately reported
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Over-the-counter allowance
Not reported in this CMS export
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Meals
In: Cost share not reported · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
Verify in plan documentsIn-networkVerify in plan documents
Out-of-networkNot separately reported
Specialist
Verify in plan documentsIn-network$40 copay
Out-of-networkNot separately reported
Preventive care
Verify in plan documentsIn-networkCost share not reported
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
Verify in plan documentsIn-network0%–15% coinsurance
Out-of-networkNot separately reported
Laboratory services
Verify in plan documentsIn-network$0–$5 copay + 0%–20% coinsurance
Out-of-networkNot separately reported
X-rays & standard imaging
Verify in plan documentsIn-network15% coinsurance
Out-of-networkNot separately reported
MRI, CT & PET imaging
Verify in plan documentsIn-network15% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network$115 copay
Out-of-networkNot separately reported
Ground ambulance
Verify in plan documentsIn-network$325 copay
Out-of-networkNot separately reported
Air ambulance
Verify in plan documentsIn-network$325 copay
Out-of-networkNot separately reported
Outpatient hospital
Verify in plan documentsIn-network$0–$300 copay
Out-of-networkNot separately reported
Outpatient surgery / ASC
Verify in plan documentsIn-network$250 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits
Home health
In-networkCost share not reported
Out-of-networkNot separately reported
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-networkCost share not reported
Out-of-networkNot separately reported
Occupational therapy
Verify in plan documentsIn-network$30 copay
Out-of-networkNot separately reported
Physical & speech therapy
Verify in plan documentsIn-network$30 copay
Out-of-networkNot separately reported
Behavioral health2 benefits
Mental health services
In-network$75 copay
Out-of-networkNot separately reported
Substance use treatment
Verify in plan documentsIn-network$75 copay
Out-of-networkNot separately reported
Specialty care2 benefits
Podiatry
Verify in plan documentsIn-network$0–$40 copay
Out-of-networkNot separately reported
Chiropractic
Verify in plan documentsIn-network$15 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits
Dental
Verify in plan documentsIn-network$40 copay
Out-of-networkNot separately reported
Vision
In-networkCost share not reported
Out-of-networkNot separately reported
Hearing
In-networkCost share not reported
Out-of-networkNot separately reported
Transportation
Not reported in this CMS exportNot reported in this CMS export
Fitness & wellness
In-networkCost share not reported
Out-of-networkNot separately reported
Over-the-counter allowance
Not reported in this CMS exportNot reported in this CMS export
Meals
In-networkCost share not reported
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview
Premium & Part B giveback
$109 Part C premium / month · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$7,000
Combined in + out$7,000
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Network & referrals
HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported
Prescription drugs6 tiers
Part D deductible
Not reported
Drug tier 1
$4 retail copay · 30-day supply
Drug tier 2
$10 retail copay · 30-day supply
Drug tier 3
25% retail coinsurance · 30-day supply
Drug tier 4
32% retail coinsurance · 30-day supply
Drug tier 5
29% retail coinsurance · 30-day supply
Drug tier 6
$4 retail copay · 30-day supply
Using this plan
Understand H5591-017-000
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
Martin's Point Generations Advantage Prime (HMO-POS) is a 2026 HMOPOS offered by Martin's Point Generations Advantage in Northeastern ME. Referrals are required for some services. Its listed inpatient copay stages total $1,750 across 5 charged days.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- Verify in plan documents
- Specialist
- $40 copay
- Laboratory services
- $0–$5 copay + 0%–20% coinsurance
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- 0%–15% coinsurance
- MRI, CT & PET imaging
- 15% coinsurance
- Outpatient hospital
- $0–$300 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $115 copay
- Listed inpatient stages
- $1,750 total
5 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- Northeastern ME (ME)
- Plan type
- HMOPOS
- Contract / plan
- H5591-017
- Coverage year
- 2026
Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Dental$40 copay
VisionCost share not reported
HearingCost share not reported
Fitness & wellnessCost share not reported
MealsCost share not reported
Plan-specific answers
Frequently asked questions
Where is H5591-017-000 available?
Martin's Point Generations Advantage Prime (HMO-POS) is listed for Northeastern ME (ME). Enrollment generally requires Medicare eligibility and residence in the plan's service area.
What is the in-network maximum out-of-pocket limit for H5591-017-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $7,000. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H5591-017-000?
The listed consolidated Part C and Part D premium is $109 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H5591-017-000?
The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.
Does H5591-017-000 report extra benefits?
Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H5591-017-000 fits
- Full CMS plan ID
H5591-017-000- Contract
H5591- Base plan code
H5591-017- Segment
000- Carrier
- Martin's Point Generations Advantage
- Plan type
- HMOPOS
- Service area
- Northeastern ME (ME)
County/service-area foundation
CMS service-area entries
Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.
- Aroostook, ME
- Franklin, ME
- Hancock, ME
- Knox, ME
- Penobscot, ME
- Washington, ME
About this code
What H5591-017-000 identifies
H5591-017-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H5591-017, H5591 017, or the compact full CMS ID H5591017000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.