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VillageCareMAX Medicare Select Advantage Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VillageCareMAX Medicare Select Advantage Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VillageCareMAX Medicare Select Advantage Plan (HMO) in 2025, please refer to our full plan details page.
VillageCareMAX Medicare Select Advantage Plan (HMO) is a HMO 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 Select Advantage Plan (HMO) 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 Select Advantage Plan (HMO).
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 Select Advantage Plan (HMO), 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 Select Advantage Plan (HMO) has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $9.00 copay for a preferred generic drug at a standard pharmacy, and 25% coinsurance for a standard generic drug. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The VillageCareMAX Medicare Select Advantage Plan (HMO) offers coverage for a variety of healthcare services. Inpatient hospital stays require a copay, but there is no copay for days 5-90. Outpatient services involve coinsurance or copays, including a $40 copay for substance abuse sessions. Emergency, urgent, and worldwide emergency services are covered with copays. This plan covers primary care, specialist visits, and therapies with copays. Hearing and vision services include routine exams, with coverage for hearing aids and eyewear. Dental services have coinsurance, and some services are covered with copays. Home health services have no copay, while skilled nursing facilities have a copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you pay a $410 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you pay a $360 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with 20% coinsurance, observation services with 20% coinsurance, ambulatory surgical center (ASC) services with a $200 copay, and outpatient substance abuse services with a $40 copay per session for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the VillageCareMAX Medicare Select Advantage Plan (HMO) with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a maximum plan benefit coverage of $50,000.
Primary Care See details
The VillageCareMAX Medicare Select Advantage Plan (HMO) covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $35 copay, physician specialist services with a $30 copay, and physical therapy and speech-language pathology services with a $40 copay. Mental health services are partially covered, as individual and group sessions are not covered. Other health care professionals are covered with a $30 copay, and psychiatric services are covered with a $40 copay. Additional telehealth benefits are covered with a 20% coinsurance, and opioid treatment program services are covered with a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The VillageCareMAX Medicare Select Advantage Plan (HMO) covers preventive services, including Medicare-covered services with no copay. Additional preventive services are partially covered, but do not include Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $375 per year, per ear, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and eyewear with 20% coinsurance. Eyewear has a combined maximum plan benefit coverage of $300.00 every year.
Dental Services See details
The VillageCareMAX Medicare Select Advantage Plan (HMO) covers dental services with a 20% coinsurance for Medicare dental services, and other dental services like oral exams, x-rays, and cleanings. Orthodontic services are covered up to a maximum of $500 per year, while 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. 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 Select Advantage Plan (HMO). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the VillageCareMAX Medicare Select Advantage Plan (HMO), with 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetic devices and medical supplies, while diabetic therapeutic shoes/inserts have a $10 copay, and durable medical equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the VillageCareMAX Medicare Select Advantage Plan (HMO). Diagnostic Procedures/Tests and Lab Services have a $10 copay, while Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the VillageCareMAX Medicare Select Advantage Plan (HMO), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the VillageCareMAX Medicare Select Advantage Plan (HMO), but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, 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. Other 1 benefits are covered with prior authorization for diabetic shoes - additional pair.
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