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VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) is a HMO D-SNP plan offered by Village Care of New York, Inc. available for enrollment in 2025 to people living in NYC boroughs, Westchester, Putnam. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) features an annual drug deductible of $615. For Tier 1 preferred generics, standard pharmacy copays range from $4.00 for a one-month supply to $12.00 for a three-month supply, while Tier 2 generics cost $8.00 for one month and $24.00 for three months. Notably, Tier 6 select care drugs offer no copay for up to a three-month supply at standard pharmacies or through standard mail order. Higher-tier medications under this plan transition to coinsurance costs instead of flat copays. Tier 3 preferred brands require a 21% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance at standard pharmacies. Standard mail order is also available for three-month supplies of Tier 3 and Tier 4 drugs at these same coinsurance rates.
Additional Benefits
The VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) offers comprehensive medical coverage with no copay for most major services, though a 20% coinsurance and prior authorization requirements frequently apply. Members enjoy no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, home health services, and preventive care. However, outpatient services, primary and specialist visits, emergency care, and diagnostic tests typically require a 20% coinsurance with no copay. This plan also includes valuable supplemental benefits such as preventive and comprehensive dental care, home infusion, and over-the-counter items with no copay and no coinsurance. Additionally, members can access routine hearing and vision services, limited transportation, and select fitness programs, which feature no copays but may involve coinsurance or annual spending limits. These combined benefits help lower out-of-pocket costs for essential healthcare and daily wellness needs.
Inpatient Hospital See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization and Medicare-defined deductibles do apply. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered under the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
The VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with a 20% coinsurance and no copay, up to $115 per visit, which counts toward the plan-level deductible and is waived if admitted to the hospital within one day. Urgently needed services also count toward the deductible and require a 20% coinsurance and no copay up to $40 per visit, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $50,000 maximum.
Primary Care See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers primary care, specialist visits, telehealth, mental health, and physical therapy with no copay and a 20% coinsurance, although prior authorization may be required. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers Medicare-covered preventive services, kidney disease education, and select other preventive services with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance (prior authorization required) and include fitness programs, remote access technologies, and up to $150 annually for safety devices, while annual physical exams and services like health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers hearing exams with no copay, though routine exams require a 20% coinsurance and are limited to one per year. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually with prior authorization, but inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are fully covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP), featuring no copays, no deductibles, and a 20% coinsurance for routine eye exams and contact lenses. The plan provides up to $350 annually for eyewear with prior authorization required, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP), featuring Medicare-covered dental care with no copay and a 20% coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with no copay and a 20% coinsurance for lab services, diagnostic procedures, X-rays, and radiological treatments. Prior authorization is required for all of these covered diagnostic and radiological services.
Home Health Services See details
Home health services are covered under the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required to access these benefits.
Cardiac Rehabilitation Services See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) offers cardiac rehabilitation services with no copay and prior authorization, meaning some services are covered. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under the plan and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered by the plan.
Other Services See details
VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers select other services, including over-the-counter (OTC) items, chronic illness meal benefits, and diabetic shoes with no copay and no coinsurance. However, some services are not covered, including acupuncture, Naloxone, and highly integrated dual eligible SNP services.
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