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:
Cost sharing and deductibles may vary based on the level of Medicaid & Extra Help that the beneficiary receives. Food & produce (grocery items), gas-at-the-pump, utilities, rent/mortgage assistance, pest control products, indoor air quality products, ride share, public transportation, transportation for non-medical needs are part of Special Supplemental Benefits for the Chronically Ill (SSBCI). In order to be eligible to receive SSBCI benefits, enrollees must be determined to be chronically ill, have a chronic condition (e.g., diabetes, chronic heart failure, cardiovascular disorder, chronic and disabling mental health conditions, stroke, or other eligible conditions), and meet coverage criteria. Members enrolled in the VillageCareMAX Medicare Total Advantage plan will qualify. Some dental service limits and prior authorization requirements apply. VillageCareMAX is an HMO plan with Medicare and New York State Medicaid contracts.
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 1-855-296-8800 (TTY: 711). We are available from 8:00 a.m. to 8:00 p.m. to answer your questions.
2026 Summary of Benefits
2026 Evidence of Coverage
This information is available for free in other languages. Please call our member services number at 1-855-296-8800 (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 an update to the maximum monthly amounts for reusable incontinence protective underpad (T4537) and reusable incontinence protective chair underpad (T4540).
Free Nurse Line
Not sure what to do or where to go? Call the new free Nurse Line. It is available after hours, on holiday, and on weekends. You will talk with a registered nurse who can help you with your medical needs and advise you on what to do. They will help you decide if your doctor, urgent care, or the hospital is the best place for you to go. This call is free for all members.
Call Member Services at 1-855-296-8800 (TTY: 711) Monday through Friday 5:00 pm to 12:00 am. On weekends and holidays call 8:00 am to 12:00 am. Outside of these hours you can select “The Nurse Line” from the prompt on the automated voicemail system.
Member Support Goals
- After-Hours Support: The Nurse Line is here to assist you during evenings, holidays, and weekends to help get you the care you need.
- Primary Care Use: Our team aims to increase your use of primary care services for better health management.
- Reduce Emergency Room Visits: Our goal is to help you avoid unnecessary trips to the emergency room.
- Safety First: Your safety is our top priority.
- Care Manager Referrals: If you have questions about home care or personal care assistant (PCA) services, we’ll refer you to your care manager for assistance.
What Our Nurse Line Can Do
- Care Referrals: The Nurse Line will discuss your symptoms with you and help you decide where to go for the care you need. Whether it’s a primary care doctor’s office, urgent care, or the emergency department.
- Follow-Up Support: After your call with the Nurse Line, we provide ongoing support to ensure your needs are met.
- Coordination with Doctors: We work with your primary care provider to help you avoid emergency room visits in the future.
- Care Manager Referrals: If you have questions about home care or personal care assistant (PCA) services, we’ll refer you to your care manager for assistance.
What Our Nurse Line Does NOT Do
- Clinical Advice: The Nurse Line will not provide clinical advice over the phone.
- Diagnoses or Dispatch: The Nurse Line does not diagnose conditions or dispatch medical services to your home unless they determine you are in crisis and require 911 assistance.
- Coordination of Home Care Services: The Nurse Line does not coordinate home care or personal care services directly.
- Prescriptions: The Nurse Line does not write prescriptions.
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, Westchester, or Putnam
- Eligible for nursing home level of care (as of the time of enrollment)
- 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 1-855-296-8800 (TTY: 711), 8:00 am to 8:00 pm for more information, 7 days a week.
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 1-855-296-8800 (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 1-855-296-8800 (TTY: 711)。
