A non-government entity
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 2026, 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 2026.
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 $12.00. 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 Great Plains Medicare Advantage (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Great Plains Medicare Advantage (HMO I-SNP) plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this upfront cost is essential when evaluating how this plan fits your budget and healthcare needs. Specific details regarding copayments, coinsurance, and drug coverage tiers are currently unavailable for this plan. To fully understand your potential out-of-pocket costs for specific prescriptions, it is recommended to contact the plan provider directly for their complete formulary. This will ensure you have the most accurate information regarding which medications are covered and their associated costs.
Additional Benefits
The Great Plains Medicare Advantage (HMO I-SNP) plan provides comprehensive coverage for core medical needs, featuring no copay for inpatient hospital stays, primary care visits, and home health services. Outpatient hospital services, specialist visits, and durable medical equipment generally require no copay but are subject to a 20% coinsurance. Emergency care is accessible with a $90 copay, while urgent care services carry a 20% coinsurance up to $40. For routine care, the plan offers dental, vision, and hearing benefits with no copay, though a 20% coinsurance applies to many of these services, alongside allowance limits for hearing aids and eyewear. Additionally, members can access up to 30 no-cost one-way transportation trips per year to plan-approved locations. However, this plan does not cover acupuncture, over-the-counter items, meal benefits, or annual physical exams.
Inpatient Hospital See details
Inpatient Hospital services are partially covered by Great Plains Medicare Advantage (HMO I-SNP), offering no copay for acute and psychiatric stays, though Medicare-defined coinsurance and cost sharing apply. Additional days, non-Medicare-covered stays, and hospital upgrades are not covered.
Outpatient Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers outpatient hospital services and ambulatory surgical center services with a 20% coinsurance, with ambulatory surgical centers requiring no copay. Outpatient substance abuse and blood services also feature no copay and a 20% coinsurance, while outpatient observation services require a $100 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by Great Plains Medicare Advantage (HMO I-SNP) with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 30 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40) and no copay, both of which count toward your plan-level deductible. These cost-sharing fees are waived if you are admitted to the hospital within three days, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Great Plains Medicare Advantage (HMO I-SNP) covers primary care physician and opioid treatment services with no copay and no coinsurance. Most other primary care benefits, such as specialist visits, therapy, and mental health services, require no copay and a 20% coinsurance, while chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers Medicare-covered preventive services, kidney disease education, and other preventive screenings with no copay and no coinsurance. However, the annual physical exam and all additional preventive services—including fitness benefits, health education, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing services covered by the Great Plains Medicare Advantage (HMO I-SNP) plan include annual routine exams with no copay and a 20% coinsurance, as well as fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 yearly limit, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Great Plains Medicare Advantage (HMO I-SNP) partially covers vision services with no deductibles, offering routine eye exams with no copay and 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to plan limits, though separate eyeglass lenses and separate eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Great Plains Medicare Advantage (HMO I-SNP), requiring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. Sub-services that are not covered include other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Great Plains Medicare Advantage (HMO I-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Great Plains Medicare Advantage (HMO I-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Great Plains Medicare Advantage (HMO I-SNP), with prior authorization required for all covered services. Covered diagnostic procedures, therapeutic radiological services, diagnostic radiological services, and outpatient X-rays feature no copay and a 20% coinsurance, while lab services are not covered.
Home Health Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers cardiac rehabilitation services with no copay, though a 20% coinsurance applies to several key services. These services subject to the 20% coinsurance include standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Great Plains Medicare Advantage (HMO I-SNP) with no copay, though Medicare-defined coinsurance and a prior three-day inpatient hospital stay are required. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Great Plains Medicare Advantage (HMO I-SNP) plan, which excludes coverage for acupuncture, over-the-counter (OTC) items, and meal benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved