VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP)

VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) is a HMO D-SNP plan offered by Village Senior Services Corporation available for the 2026 plan year 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.

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.

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:

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.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.