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:
Food & produce (grocery items), utilities, gas-at-the-pump, rent/mortgage assistance, and transportation for non-medical needs are a 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 (i.e. diabetes, chronic heart failure, cardiovascular disorder, chronic and disabling mental health conditions, stroke and/or other eligible conditions not listed), and meet coverage criteria.
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 users call 711). We are available from 8:00 a.m. to 8:00 p.m. to answer your questions.
2025 Summary of Benefits
2025 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 update to the maximum monthly amounts for reusable incontinence protective underpad (T4537) and reusable incontinence protective chair underpad (T4540).
For CDPAP Recipients and Caregivers: Action Needed by MARCH 28, 2025.
CDPAP Recipients and Caregivers are required to transition to the selected Statewide Fiscal Intermediary, Public Partnership, LLC (PPL). The deadline to transition to PPL is Friday, March 28, 2025.
View a copy of the CDPAP Registration Flyer - English - Español (PDF).
How to Switch to PPL
Between now and March 28, 2025, you can choose any of the options below to transition to PPL. Existing CDPAP consumers and PAs must complete the transition to PPL as the fiscal intermediary by March 28 to continue CDPAP services. Consumers and PAs new to CDPAP services will be able to register with PPL starting March 1.
Option 1: Transition Over the Phone
Call the customer support center at 1-833-247-5346, and they will walk you through the process. Also available: 1-833-278-4829 (Arabic), 1-833-279-3511 (French), 1-833-279-3513 (Haitian Creole), 1-833-281-0927 (Spanish), 1-833-204-9042 (TTY)
Option 2: Transition Online
You can switch to PPL using the PPL@Home online system. Access PPL@Home by clicking the appropriate link below.
Sign up with Your Email Address
Sign up with Your Cell Phone Number
Option 3: Transition with a CDPAP Facilitator
CDPAP facilitators can help you switch to PPL. See a list of approved facilitators.
Option 4: Transition at a Registration Session
Join an in-person or virtual session for dedicated support with the transition. See upcoming session dates.
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), 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 1-855-296-8800 (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)。
