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Neighborhood Dual CONNECT (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Neighborhood Dual CONNECT (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Neighborhood Dual CONNECT (HMO D-SNP) in 2026, please refer to our full plan details page.
Neighborhood Dual CONNECT (HMO D-SNP) is a HMO D-SNP plan offered by NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND available for enrollment in 2026 to people living in Bristol, Kent, Newport, Providence and Washington. The overall rating for this plan is not yet available for 2026.
It's important to know that Neighborhood Dual CONNECT (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Neighborhood Dual CONNECT (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Neighborhood Dual CONNECT (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Neighborhood Dual CONNECT (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Neighborhood Dual CONNECT (HMO D-SNP) prescription drug benefit features an annual drug deductible of $615. You must pay this deductible amount out-of-pocket before the plan begins to pay for your covered prescription medications. Specific drug coverage tier details, including individual copayments and coinsurance percentages, are not available for this plan. To determine your actual out-of-pocket costs, you will need to check the plan's formulary to see how your specific medications are covered.
Additional Benefits
The Neighborhood Dual CONNECT (HMO D-SNP) plan offers comprehensive medical coverage featuring no copayments for several key services, including inpatient hospital stays, home health visits, and skilled nursing care. For many other essential services, such as outpatient care, emergency visits, primary and specialist care, and diagnostic testing, members will pay no copay but are responsible for a 20 percent coinsurance. Additionally, Medicare Part B drugs generally feature no copay and up to a 20 percent coinsurance, though insulin requires a $35 copay. While the plan covers Medicare-approved dental, vision, and diagnostic hearing services with no copay and a 20 percent coinsurance, routine exams, eyeglasses, and hearing aids are not covered. Members also benefit from a chronic illness meal benefit and a $25 monthly allowance for over-the-counter items, both available with no copay or coinsurance. However, routine transportation and cardiac rehabilitation services are excluded from this plan.
Inpatient Hospital See details
Neighborhood Dual CONNECT (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay or coinsurance, although prior authorization is required for acute care. Unlimited additional days are covered, but the benefit is only partially covered as upgrades and non-Medicare-covered stays are excluded.
Outpatient Services See details
Neighborhood Dual CONNECT (HMO D-SNP) covers outpatient services with no copay, but a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Neighborhood Dual CONNECT (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Neighborhood Dual CONNECT (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are partially covered by Neighborhood Dual CONNECT (HMO D-SNP), requiring a 20% coinsurance and no copay (up to a $115 maximum per visit) for emergency care, and a 20% coinsurance and no copay (up to a $40 maximum per visit) for urgent care. Worldwide emergency and urgent services are covered with no copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Neighborhood Dual CONNECT (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, and therapy services with no copay and up to 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Neighborhood Dual CONNECT (HMO D-SNP), featuring annual physical exams with no copay and no coinsurance, and kidney education and select screenings with no copay and 20% coinsurance. While physical and memory fitness benefits are covered, other services—including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling—are not covered.
Hearing Services See details
Hearing services under Neighborhood Dual CONNECT (HMO D-SNP) are partially covered, offering diagnostic hearing exams with no copay and no coinsurance, while routine exams and hearing aid fittings are not covered. For prescription hearing aids, some services are covered but inner ear, outer ear, and over-the-ear devices are not covered, and OTC hearing aids are excluded entirely.
Vision Services See details
Neighborhood Dual CONNECT (HMO D-SNP) covers some vision services with no copay, no deductible, and 20% coinsurance. However, routine eye exams, other eye exam services, contact lenses, eyeglasses, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Neighborhood Dual CONNECT (HMO D-SNP), which provides Medicare-covered dental services with no copay and a 20% coinsurance, though prior authorization is required. Other dental services, including preventive cleanings, exams, x-rays, and orthodontic or restorative treatments, are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Neighborhood Dual CONNECT (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Neighborhood Dual CONNECT (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Neighborhood Dual CONNECT (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Neighborhood Dual CONNECT (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization requirements. This comprehensive coverage includes outpatient diagnostic procedures, lab services, x-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Neighborhood Dual CONNECT (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Neighborhood Dual CONNECT (HMO D-SNP) plan, as specific sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation—are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Neighborhood Dual CONNECT (HMO D-SNP) with no copay and no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required for this benefit, though the plan does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
Neighborhood Dual CONNECT (HMO D-SNP) provides partial coverage for other services, with acupuncture not covered. Covered benefits include a chronic illness meal benefit and over-the-counter (OTC) items up to $25 monthly, both of which feature no copay and no coinsurance.
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