2023 Benefits & Services

Members get all covered Medicare and Medicaid benefits directly from VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP), including Long-term Services and Supports (LTSS) and prescription drugs. In addition, you get extra benefits that are not covered by Medicare or Medicaid. Your Care Manager will work with you, your family and a team of providers to help determine what services will best meet your needs.


Benefits

You pay no co-pays, deductibles or monthly premium for covered services.

You will pay nothing for benefits such as:


Up to $225 per month ($2,700 per year) on your Over-the-Counter (OTC) card to purchase health-related items, approved non-prescription drugs and Grocery Items*
Up to $2,000 per year ($500 per quarter) for comprehensive dental services not covered by Medicaid (like additional crowns, dentures and fillings)
Unlimited medical transportation to and from your medical appointments
Acupuncture treatments beyond Medicare coverage. 50 acupuncture visits per year (limit to 5 visits per month)
1 eye exam per year
$350 per year for eyewear (eye glasses and contact lenses)
Fitness Membership at participating locations, home fitness kits, and telephone coaching
 
12 one-way trips per year for Transportation for Non-Medical Needs*
Doctor Visits
Preventive services including bone mass measurement, diabetes screenings, cancer screenings, flu shots, and glaucoma tests
Long term services and supports including Personal Care, Private Duty Nursing, Social Day Care, and Home Delivered Meals
Personal Emergency Response System (PERS)
Physical therapy, occupational therapy and speech & language therapy visits
Diagnostic testing (including X-ray, EKG, MRI, CT Scans)
Inpatient hospital and skilled nursing facility services
Mental Health and Substance Use Disorder Services
Up to $50,000 per year for Worldwide Emergency/Urgent Care Coverage and Emergency Transportation when you travel outside of the United States and its territories. 
Durable Medical Equipment (DME) and supplies
Medicare Part D prescription drug coverage

*Food & Produce (grocery items) and Transportation for Non-Medical Needs are part of Special Supplemental Benefits for the Chronically Ill (SSBCI) and not all members will qualify. Generally, members enrolled in VillageCareMAX will qualify.

You can learn more about the services that are available to VillageCareMAX Medicare Total Advantage members, by downloading and reviewing the following booklets or contacting us at 1-800-469-6292 (TTY users call 711). We are available from 8:00 a.m. to 8:00 p.m. to answer your questions.

2023 Summary of Benefits
2023 Evidence of Coverage

This information is available for free in other languages. Please call our member services number at 1-800-469-6292 (TTY: 711) during the hours of 8:00 am to 8:00 pm, 7 days a week. You can get this information for free in other formats, such as large print, braille, or audio. You must continue to pay your Medicare Part B premium. This information is not a complete description of the benefits.


Benefits Updates

Durable Medical Equipment, Prosthetic, Orthotics, and Supplies (DMEPOS) Medical Supply Quantity Update

  • This DME Medical Supplies Monthly Quantity Update for urinary catheter with insertion supplies (A4353) are effective for dates of service beginning March 1, 2022.
    • The DME Procedure Code Manual has been updated for June 1, 2022. Any changes reflected in the manual are effective for dates of service beginning June 1, 2022. 
  • Changes include update to the maximum monthly amounts for reusable incontinence protective underpad (T4537) and reusable incontinence protective chair underpad (T4540).

Who Can Join

You can join VillageCareMAX Medicare Total Advantage Plan if you:

  • Are 18 years of age or older
  • Have full Medicaid, Medicare Part A, and Part B
  • Live in Brooklyn, Bronx, Manhattan, Queens, Staten Island, Nassau, or Westchester
  • Require community-based long term care services for a continuous period of more than 120 days

How To Join

Call VillageCareMAX to schedule an appointment with an assessment nurse and licensed marketing representative.

Call us at 1-800-469-6292 (TTY 711), 7 days a week 8 am to 8 pm for more information.


Contract Statement

VillageCareMAX is an HMO plan with Medicare and New York State Medicaid contracts. Enrollment in VillageCareMAX depends on contract renewal.

VillageCareMAX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-469-6292 (TTY: 711).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-469-6292 (TTY: 711)。

Page Last Updated: 11/16/2022