Neighborhood Dual CONNECT (HMO D-SNP) H2126-001 • 2026 • Providence County, RI
Neighborhood Dual CONNECT is a Medicare Dual-Eligible plan offered by Neighborhood Health Plan of Rhode Island for the 2026 plan year. It is identified by CMS Plan ID H2126-001 and serves individuals who meet defined eligibility criteria.
Neighborhood Dual CONNECT Overview
Plan Overview for
H2126-001-0
|
|
|---|---|
| CMS Plan ID: |
H2126-001-0
|
| Plan Type: | HMO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: |
$18.20
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Providence County, RI |
| Enrollment (Nationwide): | 24 beneficiaries |
| Enrollment (CMS – Local) | 24 beneficiaries in Providence County |
| Provided By: | Neighborhood Health Plan of Rhode Island |
Plan Overview and Eligibility
Neighborhood Dual CONNECT is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).
| Special Needs Plan Type: | Dual-Eligible Special Needs Plan (D-SNP) |
|---|---|
| Medicare Requirement: | Medicare Part A and Part B |
| Special Needs Requirement: | Must qualify for Medicaid |
| Service Area Requirement: | Must live in the plan's service area |
| Prescription Drug Coverage: | Medicare Part D prescription drug coverage is included. |
Neighborhood Dual CONNECT operates on a Health Maintenance Organization (HMO) network. Members usually access care through in-network providers, and referrals are often needed for specialty services. The plan covers emergency services and out-of-area dialysis regardless of network status.
Covered Services & Costs
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0 copay |
| Specialist: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0 copay | Out-of-network: $0 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $0 copay |
| Worldwide emergency care: | $0 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $0 per day for days 1-60 | $0 per day for days 61-90 | $0 per day for days 91-150 |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100 |
| Ground ambulance: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per day for days 1-60 | $0 per day for days 61-90 | $0 per day for days 91-150 |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Occupational therapy: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: $0 copay |
| Durable medical equipment: | In-network: $0 copay | Out-of-network: $0 copay |
| Prosthetics: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Other Part B drugs (Medicare-covered): | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | Not covered |
| Dental x-rays: | Not covered |
| Cleaning: | Not covered |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | Not covered |
| Contact lenses: | Not covered |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | Not covered |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | Not covered |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Neighborhood Dual CONNECT as a Part B benefit.
Prescription Drug Coverage
Neighborhood Dual CONNECT includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Basic Part D Premium: | $18.20 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $18.20 |
| Low-Income Premium Subsidy: | $35.76 |
| Low-Income Premium Subsidy Paid by CMS: | $18.20 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Neighborhood Health Plan of Rhode Island starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Neighborhood Dual CONNECT may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Quality Ratings (CMS)
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | Plan too new to be measured |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for Neighborhood Health Plan of Rhode Island
| Contact Type | Details |
|---|---|
| Website: | Neighborhood Health Plan of Rhode Island Plan Page |
| New Members: | 1-866-696-4774 |
| Existing Members: | 1-844-812-6896 |
| Plan Address: | 910 Douglas Pike | Smithfield, RI 02917 |
Enrollment status and eligibility information are available through the Social Security Administration . Additional information about Medicare Advantage is available at medicare.gov .
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Neighborhood Health Plan of Rhode Island (official source) | http:// | October 13, 2025 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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