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VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VillageCareMAX Medicare Total 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 Total Advantage Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
VillageCareMAX Medicare Total 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, Nassau, Westchester, Putnam. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that VillageCareMAX Medicare Total 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 Total 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 Total 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 Total 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 Total Advantage Plan (HMO D-SNP) has a $590 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. In the initial coverage phase, you will pay a $3 copay for preferred generic drugs at a standard pharmacy, 25% coinsurance for standard generic drugs, 27% coinsurance for preferred brand drugs, 25% coinsurance for non-preferred drugs, and no copay for specialty tier drugs at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) offers a range of benefits with varying cost-sharing. Many services, including primary care, outpatient, and emergency services, have a 20% coinsurance. The plan also includes coverage for hearing and vision services with coinsurance for exams and eyewear, and dental services with a 20% coinsurance for most services. This plan provides additional benefits such as home health services with no copay, and coverage for medical equipment and home infusion services, with a coinsurance for some services. The plan also includes acupuncture and over-the-counter items, with specific coverage limits. The plan requires prior authorization for some services and refers to Original Medicare for cost-sharing on services like inpatient hospital stays and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare stays, and upgrades for both are not covered. The plan requires prior authorization and refers to Original Medicare for cost sharing, with details on coinsurance and deductibles available in the plan documents.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, while ambulatory surgical center services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the VillageCareMAX Medicare Total 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 Total Advantage Plan (HMO D-SNP). Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay; however, 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. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Emergency Services has a maximum per visit amount of $110.00 while Urgently Needed Services has a maximum per visit amount of $45.00. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.00.
Primary Care See details
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 are covered, with a 20% coinsurance. Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
The VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) offers preventive services, including Medicare-covered services with no copay, but annual physical exams are not covered. Additional preventive services are partially covered, with health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services not covered. Other services like fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered.
Hearing Services See details
Hearing services include coverage for hearing exams with at most 20% coinsurance, and prescription hearing aids (all types) and OTC hearing aids with no coinsurance. Routine hearing exams, and fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Routine eye exams are covered once per year. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year. Upgrades are not covered.
Dental Services See details
The VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers dental services with a 20% coinsurance for Medicare dental services, and other dental services are also covered. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP). The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment are covered. DME and diabetic supplies have a 20% coinsurance, while DME for use outside the home is not covered. Medical supplies and diabetic therapeutic shoes/inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a coinsurance of at most 20% for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with prior authorization, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for some services, but specific details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) and require prior authorization. The plan follows Original Medicare for SNF services, and does not cover additional days beyond Medicare-covered, or non-Medicare-covered stays.
Other Services See details
The VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers acupuncture with a maximum plan benefit coverage amount of $80 per visit, with a maximum of 5 visits per month, up to 54 visits per year, and also offers over-the-counter items with a maximum benefit of $300 every month, which carries over if unused. Other services, including meal benefits, are not covered.
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