2025 Benefits & Services

Benefits

VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP) members get all covered Medicare and many non-Medicare 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:

Up to $1,500 per year ($125 per month) - Plan members can take advantage of an extra $1500 FLEX benefit they can choose to use for dental, vision, or hearing in addition to their standard coverage.
$195 per month ($2,340 per year) on your Over-the-Counter (OTC) card to purchase health-related items, approved non-prescription drugs including OTC COVID-19 tests and OTC hearing aids, Gas-at-the-Pump, Rent/Mortgage Assistance, Grocery Items, and Home Utilities including gas, electric, water, and internet/telecommunications.
$0 copay, no allowance limit.
Eye exam $0 copy.
Up to $300 for eyewear unlimited contacts, 1 pair of glasses, lenses, and frames per year. FLEX Benefits can be used for additional vision coverage.
36 one-way trips per year to medical appointments, up to 24 one-way (12 round trips) per year for transportation for Non-Medical Needs.
1 routine hearing exam per year.
Up to $1,500 per year for 2 hearing aids limited to $750 per ear. Flex Benefits can be used for additional hearing coverage.
Acupuncture treatments above Medicare coverage. 32 acupuncture visits per year. Limited to 8 visits per month. (up to $80 limit per visit).
Fitness Membership at participating locations and home fitness kits as well as telephone coaching.
Up to $150 per year for covered Home and Bathroom Safety Devices.  1 In-Home Safety Evaluation per year (required in order to get safety devices).
Doctor visits
$0 preventive services including bone mass measurement, diabetes screenings, cancer screenings, flu shots, and glaucoma tests.
Diagnostic testing including X-ray, EKG, MRI, and CT Scans).
Inpatient hospital and skilled nursing facility services.
Up to $50,000 per year for Worldwide Emergency/Urgent Care Coverage and Emergency Transportation when you travel outside of the United States and its territories. 
Durable Medical Equipment (DME) and supplies.
One additional pair of diabetic shoes per year above the Medicare limit.
Medicare Prescription Drug Coverage (Part D), including supplemental drug coverage for select cough suppressants and erectile dysfunction medications with convenient delivery options.

Cost sharing and deductibles may vary based on the level of Medicaid & Extra Help that the beneficiary receives. Food & produce (grocery items), utilities, gas-at-the-pump, rent/mortgage assistance, and transportation for non-medical needs are a part of Value Based Insurance Design (VBID). Generally, members enrolled in VillageCareMAX Health Advantage FLEX Plan will qualify. Some dental service limits and prior authorization requirements apply.

You can learn more about the services that are available to VillageCareMAX Medicare Health Advantage FLEX members, by downloading and reviewing the following booklets, or by contacting us at 1-855-296-8800 (TTY users call 711). We are available 7 days a week, 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 not a complete description of the benefits. Premium, 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.

Who Can Join

You can join VillageCareMAX Medicare Health Advantage FLEX Plan if you:

  • Live in Bronx, Brooklyn, Manhattan, Queens, Staten Island, Westchester, or Putnam
  • Have Medicare Parts A and B
  • Have Medicaid

How To Join

There are three ways to join:

  1. 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 am to 8 pm.
  2. 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
  3. Medicare beneficiaries may also enroll in VillageCareMAX Medicare Health Advantage FLEX (HMO D-SNP) 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).
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