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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 Total Advantage Plan (HMO D-SNP) features an annual prescription drug deductible of $615. For cost-effective medications, the plan offers no copay for Tier 6 select care drugs at standard pharmacies and through standard mail order. Additionally, Tier 1 preferred generics and Tier 2 generics are highly affordable, with standard pharmacy copays starting at just $2.00 and $5.00 for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance at standard pharmacies. Tier 3 preferred brands require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Standard mail order options are also available for three-month supplies on most tiers to help you conveniently manage your healthcare expenses.
Additional Benefits
The VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) offers comprehensive medical coverage featuring no copay for inpatient hospital stays, skilled nursing facility care, and home health services, though a deductible or prior authorization may be required. For outpatient services, primary care visits, emergency care, and diagnostic testing, members will generally pay no copay alongside a 20% coinsurance. Key supplemental benefits like preventive care, over-the-counter items, and select dental and hearing services are also covered with no copay and no coinsurance, including up to $625 per ear annually for prescription hearing aids. Vision care includes no copays for exams alongside a $350 annual eyewear allowance, while durable medical equipment and dialysis services require no copay and a 20% coinsurance.
Inpatient Hospital See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though a deductible and prior authorization are required. Coverage follows Original Medicare guidelines, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
The VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit, waived if admitted to the hospital within 24 hours) and no copay, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with no copay and no coinsurance.
Primary Care See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers primary care, specialist visits, telehealth, and therapy services with no copay and 20% coinsurance. Chiropractic services are partially covered, with routine and other chiropractic services not covered, while podiatry services are not covered.
Preventive Services See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) provides partial coverage for preventive services with no copay and no coinsurance for covered benefits, which include Medicare-covered zero-dollar preventive services, kidney disease education, fitness programs, and remote access technologies. However, several sub-services are not covered under this plan, including annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) with no copay and no coinsurance, though routine hearing exams and fitting/evaluation services are not covered. Prescription hearing aids are covered up to $625 per ear every year with no copay or coinsurance, but inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) with no deductibles, featuring no copays for exams and eyewear alongside a 20% coinsurance for routine eye exams and contact lenses. A $350 annual combined maximum is provided for eyewear, but upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental care. Other preventive and comprehensive dental benefits are partially covered with no copay and no coinsurance, though maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin requires 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 Total Advantage Plan (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and X-rays, with prior authorization required. There is no copay for these services, and they are subject to a 20% coinsurance.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) feature some covered services with no copay, though several key treatments are not covered. Intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay or coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) provides partial coverage for other services, including acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and Naloxone are not covered, and acupuncture is limited to 40 visits per year with prior authorization required.
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