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Great Plains Medicare Advantage (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Great Plains Medicare Advantage (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Great Plains Medicare Advantage (HMO I-SNP) in 2025, please refer to our full plan details page.
Great Plains Medicare Advantage (HMO I-SNP) is a HMO I-SNP plan offered by Sanford Health available for enrollment in 2025 to people living in South Dakota (partial). This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Great Plains Medicare Advantage (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Great Plains Medicare Advantage (HMO I-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 Great Plains Medicare Advantage (HMO I-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 Great Plains Medicare Advantage (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.60. 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 $590.00 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 $9350.00 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 Great Plains Medicare Advantage (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. The plan's formulary will provide specific details on what drugs are covered. If you qualify for the low-income subsidy (LIS), your Part D premium will be $50.60. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Great Plains Medicare Advantage (HMO I-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, and some preventive services with no copay. The plan also provides coverage for vision, hearing, and dental services, with varying coinsurance amounts and limits. You will pay coinsurance for many services, including outpatient hospital services, ambulance services, and specialist visits.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. You will pay the Medicare-defined cost share for tier 1, and should refer to the plan details for more coinsurance information.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a 20% coinsurance, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with 20% coinsurance for individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Great Plains Medicare Advantage (HMO I-SNP) plan. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location are covered for up to 29 one-way trips per year.
Emergency Services See details
Emergency Services for the Great Plains Medicare Advantage (HMO I-SNP) plan has a $90 copay and no coinsurance. Urgently Needed Services have 20% coinsurance and no copay, and Worldwide Emergency Services are not covered.
Primary Care See details
The Great Plains Medicare Advantage (HMO I-SNP) plan covers primary care physician services with no copay and no coinsurance, chiropractic services with a 20% coinsurance, occupational therapy services with a 20% coinsurance, physician specialist services with a 20% coinsurance, mental health specialty services with a 20% coinsurance, podiatry services with a 20% coinsurance, other health care professional services with a 20% coinsurance, psychiatric services with a 20% coinsurance, physical therapy and speech-language pathology services with a 20% coinsurance, additional telehealth benefits with a 0-20% coinsurance, and opioid treatment program services.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, with no copay. However, annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20% and one visit per year, and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $2,000 per year, while prescription hearing aids for the inner, outer, and over-the-ear are not covered.
Vision Services See details
The Great Plains Medicare Advantage (HMO I-SNP) plan covers vision services, including routine eye exams with a 20% coinsurance. Eyewear is also covered, including contact lenses (1 pair per year, up to $100), and eyeglasses (lenses and frames) (1 pair per year, up to $300). Eyeglass lenses and frames are not covered.
Dental Services See details
The Great Plains Medicare Advantage (HMO I-SNP) plan covers dental services including Medicare Dental Services with 20% coinsurance, oral exams (2 visits per year), dental x-rays (1 every 5 years), prophylaxis (cleaning) (2 visits per year), restorative services, endodontics, periodontics, maxillofacial prosthetics (1 visit per year), and prosthodontics, removable (1 visit, with a $1,500 limit that can be used towards services related to dentures, covering one set of dentures every two years), and oral and maxillofacial surgery (1 visit per year). Fluoride treatment, implant services, orthodontics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B insulin drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B insulin drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Great Plains Medicare Advantage (HMO I-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization. Prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes/inserts are covered with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. All diagnostic services and radiological services have no copay and are subject to coinsurance; diagnostic procedures/tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services each have a coinsurance of at most 20%, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Great Plains Medicare Advantage (HMO I-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Great Plains Medicare Advantage (HMO I-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan, with coinsurance costs that vary. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The Great Plains Medicare Advantage (HMO I-SNP) plan does not cover acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. No authorization or referrals are required for these services.
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