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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 Select Advantage Plan (HMO) has an annual prescription drug deductible of $615. For lower-tier medications, the plan offers affordable copays, including a $2 copay for Tier 1 preferred generics and an $8 copay for Tier 2 generics for a one-month supply at standard pharmacies. Additionally, you will pay no copay for Tier 6 select care drugs at standard pharmacies or through standard mail order. For higher-tier medications, the plan utilizes a coinsurance model for standard pharmacies and mail orders. Tier 3 preferred brands require a 23% coinsurance, and Tier 4 non-preferred drugs carry a 32% coinsurance. Tier 5 specialty drugs are covered at a 25% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The VillageCareMAX Medicare Select Advantage Plan (HMO) offers affordable healthcare coverage with no copay or coinsurance for primary care doctor visits and preventive services. Specialist visits require a $15 copay, while inpatient hospital stays incur a $410 daily copay for the first four days followed by no copay for days 5 through 90. Emergency care is covered with a $115 copay, which is waived upon admission, and urgent care visits require a $40 copay. For ancillary care, the plan provides partial coverage for dental, vision, and hearing services, featuring no copays and a 20% coinsurance for routine eye and hearing exams, alongside a $1,800 maximum benefit for covered dental services. Skilled nursing facility stays feature no copay for the first 20 days, and home health services are fully covered with no copays or coinsurance. Diagnostic tests, lab work, and acupuncture are also available with no copay, ensuring key healthcare needs are accessible.
Inpatient Hospital See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers inpatient acute hospital stays with no coinsurance and a $410 daily copay for days 1 through 4 (no copay for days 5 through 90), and inpatient psychiatric stays with no coinsurance and a $360 daily copay for days 1 through 4 (no copay for days 5 through 90). Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers outpatient hospital and observation services with no copay and a 20% coinsurance, while ambulatory surgical center services require a $200 copay and no coinsurance. Outpatient substance abuse services have a $40 copay and no coinsurance, and outpatient blood services are covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the VillageCareMAX Medicare Select Advantage Plan (HMO) with a $40.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by the VillageCareMAX Medicare Select Advantage Plan (HMO) with a $115 copay, which is waived if you are admitted to the hospital within one day, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency and urgent care are covered up to a $50,000 maximum limit with matching copays and no coinsurance.
Primary Care See details
Primary care benefits under the VillageCareMAX Medicare Select Advantage Plan (HMO) are partially covered, as podiatry and chiropractic services are not covered. Patients pay no copay and no coinsurance for primary care doctor visits, a $15 copay and no coinsurance for specialists, and a $25 copay and no coinsurance for mental health and physical therapy. Telehealth services are also offered with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers Medicare-covered preventive services, kidney disease education, and other services like glaucoma screenings with no copay and no coinsurance. However, these services are only partially covered, as the annual physical exam and several additional benefits—including health education, in-home safety assessments, and personal emergency response systems—are not covered.
Hearing Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) hearing services are partially covered, offering routine hearing exams with no copay and 20% coinsurance, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to $375 per ear every two years, but inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by the VillageCareMAX Medicare Select Advantage Plan (HMO), offering no copays and no deductibles, but requiring a 20% coinsurance for routine eye exams and contact lenses. The plan covers one routine eye exam and up to $300 annually for eyewear with prior authorization, while upgrades and other eye exam services are not covered.
Dental Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) provides partial coverage for dental services, featuring a 20% coinsurance and no copay for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $1,800 annual maximum. While preventive and restorative care are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the VillageCareMAX Medicare Select Advantage Plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the VillageCareMAX Medicare Select Advantage Plan (HMO) with prior authorization required, featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered, excluding diabetic supplies but covering therapeutic shoes and inserts with a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers diagnostic and radiological services, offering diagnostic tests, lab services, and outpatient X-rays with no copay. There is no coinsurance for diagnostic services, though diagnostic and therapeutic radiological services require a 20% coinsurance, and prior authorization is required.
Home Health Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
VillageCareMAX Medicare Select Advantage Plan (HMO) covers some cardiac rehabilitation services with no coinsurance and prior authorization, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
VillageCareMAX Medicare Select Advantage Plan (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by the VillageCareMAX Medicare Select Advantage Plan (HMO) with no copay and no coinsurance for acupuncture and over-the-counter items, though prior authorization is required for acupuncture. Meal benefits, Naloxone, and other additional services are not covered under this plan.
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