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VillageCareMAX Medicare Health Advantage FLEX 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 FLEX 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 FLEX Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
VillageCareMAX Medicare Health Advantage FLEX 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 FLEX 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 FLEX 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 FLEX 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 FLEX 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 FLEX Plan (HMO D-SNP) has an enhanced alternative drug benefit. The plan has a $590 deductible. During the initial coverage phase, after you pay the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, standard generic drugs have a 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP) offers a range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. Emergency, urgently needed, and worldwide emergency services are covered, as well as primary care and preventive services. This plan includes coverage for hearing, vision, and dental services, often with coinsurance. It also offers home infusion, dialysis, medical equipment, and diagnostic services. The plan also covers home health services with no copay, and other services, such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but the plan does not cover additional days or non-Medicare covered stays. The cost sharing details, including coinsurance and deductible, are 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, and Ambulatory Surgical Center Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 36 one-way trips per year via taxi, rideshare services, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP). For emergency services, you will pay 20% coinsurance. For urgently needed services, you will also pay 20% coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The VillageCareMAX Medicare Health Advantage FLEX 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 services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with a 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, additional preventive services, in-home safety assessments, fitness benefits, home and bathroom safety devices and modifications, kidney disease education 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, 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, and counseling 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 one per year. Prescription hearing aids are covered with a plan-specified amount per year up to $750 per ear, and OTC hearing aids are covered. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear, with a 20% coinsurance for both. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. 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), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are also covered, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment and Diabetic Supplies have a 20% coinsurance, with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP). There is no copay for any of the services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP) with no copay and no coinsurance, but prior 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 FLEX Plan (HMO D-SNP). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required, and the coinsurance is based on Original Medicare.
Other Services See details
The VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP) covers acupuncture with a maximum plan benefit coverage amount of $80 per visit, up to 8 visits per month and 32 visits per year, as well as over-the-counter items up to $195 per month, with coverage for nicotine replacement therapy. Meal benefits, 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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