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our-plan

VillageCareMAX Plan

VillageCareMAX covered benefits and services

In Home Care and Services
Home assessments
Professional nursing
Home health care
Care coordination
Personal care
Chore services and housekeeping
Home delivered meals
Physical, occupational and speech therapies

Medical Supplies and Equipment
Personal Emergency Response Systems (PERS)
Automated medication dispensers
Medical equipment
Medical and surgical supplies
Oxygen
Prosthetics and orthotics

Specialty Care
Dental care
Eye exams
Foot care
Hearing exams
Hearing aids

Rehabilitation Therapies
Physical therapy
Occupational therapy
Speech therapy
Respiratory therapy

Other Care and Services
Adult day health program
Social Day Programs
Non-emergency transportation to doctor
and health care related appointments
Help with medication management
Nutritional counseling

Keep your own doctor!

Depending on your coverage, Medicare or Medicaid will continue to cover doctor visits, hospitalizations, emergency care and prescription drug coverage.

What is important to know about VillageCareMAX?

  • It is a health plan with a benefit package of covered services.
  • The benefit package consists of long-term care services covered by Medicaid.
  • We pay for services in the benefit package, replacing Medicaid fee-for-service.
  • We coordinate all health care services for you, even those outside of the Plan’s benefit package.
  • We provide a Care Manager, and a dedicated Care Team that includes a Registered Nurse, to help you get the care that you need so that you can live the life you want.

What are the requirements to join the VillageCareMAX plan?

  • 18 years of age or older.
  • Medicaid eligible.
    • Nursing home eligibility may be required at the time of enrollment.
  • Capable, at the time of enrollment, of returning to or remaining in your home and community.
  • Expected to need long-term care services and case management from the plan for more than 120 days.

Where is VillageCareMAX available?

  • Manhattan (New York County)
  • Brooklyn (Kings County)
  • Bronx
  • Queens

What makes VillageCareMAX special?

  • Your Care Manager will visit you in your home as long as you are a member of VillageCareMAX.
  • A team of health care professionals will work closely with you to coordinate the care you need.
  • A personalized care plan is created every six months based on medical necessity:
    • The care plan is a written description of your services and how they will be provided.
    • The care plan includes measurable goals and objectives.
  • Members are assessed on an ongoing basis in their homes or by phone by their dedicated Care Manager.

What if I have other health insurance?

If you have any additional health insurance, it is important for you to keep your insurance for services that VillageCareMAX does not cover.

VillageCareMAX will coordinate benefits with your insurance company.

How does VillageCareMAX affect Medicaid and Medicare coverage?

  • VillageCareMAX does not change your Medicare or Medicaid benefits.
  • You continue to receive all of your Medicaid long term care services through the plan.
  • You may keep your primary care physician.
  • If a service is usually covered by Medicaid and/or Medicare, but is not covered by VillageCareMAX, you can continue to receive the service outside of the Plan using your Medicaid or Medicare card.

How do I get the services that I need?

  • Upon enrollment, you and your care team (including your doctor, your care manager, your caregivers) will work together to develop a plan of care that meets your needs.
  • Requests for new services or for changes in your current plan should be made by calling your care manager at 800-4MY-MAXCARE (800-469-6292). If the service is medically necessary, the Plan will authorize the service through our network of providers.
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