Benefits
VillageCareMAX Medicare Select Advantage Plan (HMO) members get all covered Medicare and many non-Medicare covered benefits. Your Care Manager will work with you and your providers to meet your needs. You receive Medicare-covered benefits and extra benefits such as:
and 23% for preferred brand names.
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. 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. Not all members may qualify. Some dental service limits and prior authorization requirements apply.
You can learn more about the services that are available to VillageCareMAX Medicare Select Advantage Plan members by downloading and reviewing the following booklets or contacting us at 1-855-296-8800 (TTY: 711). We are available 7 days a week, from 8:00 am to 8:00 pm to answer your questions.
2026 Summary of Benefits
2026 Evidence of Coverage
This information is not a complete description of benefits. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or co-payments/co-insurance may change on January 1 of each year. Contact the plan for more information.
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
Who Can Join
You can join the VillageCareMAX Medicare Select Advantage Plan if you:
- Are not receiving Medicaid
- May or may not receive Extra Help
- Live in Bronx, Brooklyn, Manhattan, Queens, Staten Island, Nassau, Westchester, or Putnam
How To Join
There are three ways to join:
- Call VillageCareMAX to schedule an appointment with a licensed sales agent. Call us at 1-855-296-8800 (TTY: 711), 7 days a week, 8:00 am to 8:00 pm.
- Download and complete an Enrollment Request Application. Download it in English (coming soon), Spanish [Español] (coming soon), or Chinese [中文] (coming soon). Complete the form and send it to us by mail to VillageCareMAX, 112 Charles Street, New York, NY 10014
- Medicare beneficiaries may also enroll in VillageCareMAX Medicare Select Advantage Plan (HMO) through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov. Call 1-800-Medicare (1-800-633-4227). TTY: 1-877-486-2048.
