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Neighborhood INTEGRITY for Duals (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Neighborhood INTEGRITY for Duals (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 INTEGRITY for Duals (HMO D-SNP) in 2026, please refer to our full plan details page.
Neighborhood INTEGRITY for Duals (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 INTEGRITY for Duals (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 INTEGRITY for Duals (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 INTEGRITY for Duals (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 INTEGRITY for Duals (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.60. 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:
Sign up for Neighborhood INTEGRITY for Duals (HMO D-SNP)
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Drug Coverage
The Neighborhood INTEGRITY for Duals (HMO D-SNP) plan features an annual drug deductible of $615. For prescription drug coverage, this plan offers significant savings with no copay for both Tier 1 (Preferred Generic) and Tier 2 (Generic) medications. This no-cost benefit applies to one-month, two-month, and three-month supplies filled through standard pharmacies or standard mail order. For higher-tier medications, beneficiaries will pay a 25% coinsurance. This 25% cost-sharing rate applies to Tier 3 (Preferred Brand) and Tier 4 (Non-Preferred Drug) prescriptions across all supply lengths, as well as one-month supplies of Tier 5 (Specialty Tier) drugs. These rates remain the same whether you use a standard retail pharmacy or a standard mail-order service.
Additional Benefits
The Neighborhood INTEGRITY for Duals (HMO D-SNP) offers robust healthcare coverage featuring no copays for key medical services, though many outpatient and specialist visits require a 20% coinsurance. Inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. Emergency and urgent care services are also available with no copay and a 20% coinsurance, which includes worldwide emergency coverage. For extra benefits, the plan provides dental coverage with no copay and a 20% coinsurance for Medicare-covered care, plus up to $1,250 annually for other dental services with no copay and no coinsurance. Members also benefit from a fitness program and a $28 monthly over-the-counter allowance with no copay and no coinsurance. However, it is important to note that routine vision and hearing exams, eyeglasses, and hearing aids are not covered by this plan.
Inpatient Hospital See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, offering unlimited additional days of coverage. This benefit is partially covered because upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Neighborhood INTEGRITY for Duals (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency Services under the Neighborhood INTEGRITY for Duals (HMO D-SNP) are covered with a 20% coinsurance and no copay, up to a maximum of $115 per visit for emergency care and $40 per visit for urgent care. Worldwide emergency and urgent care are partially covered with no copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) covers primary care, specialist, psychiatric, therapy, telehealth, and opioid treatment services with no copay and 20% coinsurance (0% to 20% for opioid treatment). Chiropractic and podiatry services are not covered, and prior authorization is required for telehealth, occupational therapy, and physical or speech therapy.
Preventive Services See details
Preventive services are covered by Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay and no coinsurance for annual physical exams, while kidney disease education and other screenings (including glaucoma and diabetes self-management) require no copay and a 20% coinsurance. Additional preventive services are partially covered, offering a fitness benefit with no copay and no coinsurance, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home/bathroom safety, and counseling.
Hearing Services See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) covers diagnostic hearing exams with no copay and no deductible, though there is no coinsurance for these covered exams. However, routine hearing exams, fitting evaluations, and both prescription and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are offered by Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay, 20% coinsurance, and no deductible, but only some services are covered in practice. Routine eye exams, other eye exam services, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, and other dental services up to a $1,250 annual maximum with no copay and no coinsurance. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and 20% coinsurance. Prior authorization is required for these covered medical equipment benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay and a 20% coinsurance, and prior authorization is required. This coverage applies to outpatient diagnostic procedures and tests, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Neighborhood INTEGRITY for Duals (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Neighborhood INTEGRITY for Duals (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission with less than a three-day prior inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Neighborhood INTEGRITY for Duals (HMO D-SNP) offers partial coverage for other services, which includes a meal benefit for chronic illness and a $28 monthly allowance for over-the-counter items with no copay and no coinsurance. Acupuncture and highly integrated services for dual eligibles are not covered under this benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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