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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 2025, 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 out of 5 stars in 2025.
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 $72.30. 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 $590.00 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 $9350.00 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) has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after meeting your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard pharmacy, you will pay a $5.00 copay for preferred generic drugs and 25% coinsurance for standard generic drugs. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered Part D drugs.
Additional Benefits
The VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) offers a variety of benefits with varying cost-sharing. Many services, including outpatient services, primary care, hearing, vision, and dental services, have a 20% coinsurance. Emergency services and ambulance services also have a 20% coinsurance, while preventive services and home health services may have no copay. The plan also includes additional benefits such as coverage for hearing aids, vision eyewear, and up to $265 monthly for over-the-counter items. Some services, like inpatient hospital stays, skilled nursing facility stays, and home infusion bundled services, require prior authorization, and the coinsurance or copay information is available in the plan details.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP). The plan requires prior authorization and the cost sharing information, including coinsurance and deductible, is available in the plan details.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient substance abuse services have a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the VillageCareMAX Medicare Health Advantage Plan, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 36 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by this plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, with a maximum per visit amount of $110 and $45 respectively, and Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with a 20% coinsurance. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) covers preventive services including Medicare-covered zero-dollar preventive services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Annual physical exams, health education, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20%, and routine hearing exams are limited to 1 per year. Prescription hearing aids are covered up to a maximum of $750 per year, and OTC hearing aids are also covered.
Vision Services See details
Vision services include eye exams, eyewear, and upgrades. Eye exams have a 20% coinsurance for routine eye exams. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, all have a 20% coinsurance, with a combined maximum benefit of $350 every year. Upgrades are not covered.
Dental Services See details
Dental services are covered with 20% coinsurance for Medicare Dental Services; other dental services include oral exams, dental x-rays, and other diagnostic dental services, all of which require prior authorization. Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP). Durable medical equipment has a 20% coinsurance, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies and diabetic therapeutic shoes/inserts have a 20% coinsurance as well.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP). Diagnostic Procedures/Tests and Lab Services have no copay, but have a coinsurance of at most 20%. Radiological services, including Diagnostic and Therapeutic Radiological Services and Outpatient X-Ray Services, also have no copay, but have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP), but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance information is available in the plan details.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $265.00 every month, and a Meal Benefit for chronic illnesses, which requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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