2023 Plan Materials and Resources

Plan Materials

2023 Evidence of Coverage

2023 Provider and Pharmacy Directory

Expansion Counties Effective 1/1/2023:

Nassau (updated 1/2023)

Staten Island (updated 1/2023)



2023 Formulary

Appointment of Representative Form

Part D Coverage Determination Form

Member Reimbursement Form

Prescription Drug Mail Order Form

Privacy Notice

Part D Coverage Re-Determination Form

Plan Resources

Member Resources

*By clicking these links, you will be leaving VillageCareMAX website.

New York Medicaid Choice – Enrollment Broker

CMS Best Available Evidence Policy

Submit a complaint to Medicare

Medicaid Ombudsman Office

The State of New York has created an ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide members with free, confidential assistance on any services offered by VillageCareMAX Medicare Total Advantage Plan. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org

Medicare Ombudsman Office

Page Last Updated: 09/15/2023