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VillageCareMAX Medicare Select Advantage Plan (HMO)

H2168 - 004 - 0
3 out of 5 stars (3 / 5)

VillageCareMAX Medicare Select Advantage Plan (HMO) is a Medicare Advantage Plan by VillageCareMAX.

This page features plan details for 2025 VillageCareMAX Medicare Select Advantage Plan (HMO) H2168 – 004 – 0 available in NYC boroughs, Nassau, Westchester, Putnam.

Locations

VillageCareMAX Medicare Select Advantage Plan (HMO) is offered in the following locations.

Bronx County, New York
Kings County, New York
Nassau County, New York

Click to see more locations

Plan Overview

VillageCareMAX Medicare Select Advantage Plan (HMO) offers the following coverage and cost-sharing.

Insurer:VillageCareMAX
Health Plan Deductible:$0
MOOP:$9,350 In-network
Drugs Covered:Yes

Ready to sign up for VillageCareMAX Medicare Select Advantage Plan (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

VillageCareMAX Medicare Select Advantage Plan (HMO) has a monthly premium of $72.30. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $72.30 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

VillageCareMAX Medicare Select Advantage Plan (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $590.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$72.30$0.00

Initial Coverage Phase

After you pay your $590.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

VillageCareMAX Medicare Select Advantage Plan (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay
  • Endodontics
    • In-Network: No Coins – No Co pay
  • Implant Services
    • In-Network: No Coins – No Co pay (Authorization Required)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay
  • Periodontics
    • In-Network: No Coins – No Co pay
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Authorization Required)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay
  • Restorative Services
    • In-Network: No Coins – No Co pay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Authorization Required)
  • Fluoride Treatment
    • In-Network: No Coins – No Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – No Copay (Authorization Required)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Authorization Required)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Authorization Required)

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • 20% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • $10 copay (Authorization Required)
  • Outpatient x-rays
    • $25 copay (Authorization Required)
  • Lab services
    • $10 copay (Authorization Required)

Doctor visits

  • Primary
    • $0 copay
  • Specialist
    • $30 copay per visit

Emergency care/Urgent care

  • Emergency
    • $110 copay per visit (always covered)
  • Urgent care
    • $40 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • $25 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • $250 copay

Health plan deductible

    • $0

Hearing

  • Medicare-Covered Hearing Exam
    • 20% coinsurance
  • Hearing aids
    • $0 copay (Limits Apply, Authorization Required)
  • Hearing aids OTC
    • Not covered
  • Fitting/evaluation
    • $0 copay

Inpatient hospital coverage

    • $410 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $9,350 In-network

Medical equipment/supplies

  • Diabetes supplies
    • $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • $360 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • $0 copay
  • Outpatient individual therapy visit with a psychiatrist
    • $40 copay
  • Outpatient individual therapy visit
    • $0 copay
  • Outpatient group therapy visit with a psychiatrist
    • $40 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • 20% coinsurance per visit (Authorization Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Occupational therapy visit
    • $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • $40 copay (Authorization Required)

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • $0 copay (Limits Apply, Authorization Required)
  • Eyeglass frames
    • $0 copay (Limits Apply, Authorization Required)
  • Other
    • Not covered
  • Routine eye exam
    • $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglass lenses
    • $0 copay (Limits Apply, Authorization Required)
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply, Authorization Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for VillageCareMAX Medicare Select Advantage Plan (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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