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Great Plain Medicare Advantage Gold (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Great Plain Medicare Advantage Gold (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 Plain Medicare Advantage Gold (HMO I-SNP) in 2026, please refer to our full plan details page.
Great Plain Medicare Advantage Gold (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 Plain Medicare Advantage Gold (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 Plain Medicare Advantage Gold (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 Plain Medicare Advantage Gold (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 Plain Medicare Advantage Gold (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2750.00 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 Plain Medicare Advantage Gold (HMO I-SNP) prescription drug coverage features a $0 drug deductible, allowing your benefits to begin immediately. Members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies. For Tier 2 generic medications, you will pay a low $10 copay for a one-month supply at standard pharmacies. Higher-tier medications are covered with predictable copays and coinsurance at standard pharmacies. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply, while Tier 4 non-preferred drugs require a $95 copay. Specialty medications in Tier 5 are subject to a 33% coinsurance for one-month, two-month, and three-month supplies.
Additional Benefits
The Great Plain Medicare Advantage Gold (HMO I-SNP) offers robust coverage for essential medical services with predictable cost-sharing. Members benefit from no copay for primary care visits, physical therapy, and home health services, while specialist visits, urgent care, and routine eye or hearing exams require a $30 copay. Inpatient hospital stays feature a $185 daily copay for the first five days and no copay for days six through 90, with no coinsurance required. This plan also includes key supplemental benefits to reduce out-of-pocket costs, such as routine dental exams and cleanings with no copay or coinsurance, alongside allowance-based coverage for prescription eyeglasses and hearing aids. For essential travel, members receive up to 32 one-way trips per year to approved locations at no cost. Additionally, durable medical equipment, dialysis, and Medicare-covered dental services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $185 daily copay for days 1 through 5 and no copay for days 6 through 90. However, this benefit is only partially covered as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Great Plain Medicare Advantage Gold (HMO I-SNP) with no coinsurance for outpatient hospital services ($50 copay), observation services ($100 copay per stay), ambulatory surgical center services ($50 copay), and substance abuse sessions ($30 copay). Outpatient blood services are also covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Great Plain Medicare Advantage Gold (HMO I-SNP) with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers ground ambulance services with a $150 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services are partially covered with no copay and no coinsurance for up to 32 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with both copays waived if admitted to the hospital within three days. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Great Plain Medicare Advantage Gold (HMO I-SNP) provides primary care, occupational therapy, physical therapy, speech-language pathology, and opioid treatment with no copay and no coinsurance. Specialist visits, mental health, and psychiatric services require a $30 copay with no coinsurance, while chiropractic services are partially covered (excluding other chiropractic services) with copays up to $30 and no coinsurance. Podiatry services feature no copay with 0% to 20% coinsurance, and telehealth benefits range from a $0 to $30 copay with no coinsurance.
Preventive Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) partially covers preventive services, offering Medicare-covered zero-dollar services, kidney disease education, and screenings with no copay and no coinsurance. Annual physical exams and additional preventive services, including fitness benefits, health education, and home safety assessments, are not covered.
Hearing Services See details
Hearing services are covered by Great Plain Medicare Advantage Gold (HMO I-SNP), including routine hearing exams for a $30 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual maximum, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) offers partially covered vision services with no deductibles, including routine eye exams for a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to $100 yearly for contact lenses and $275 yearly for eyeglasses, but individual eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are partially covered by Great Plain Medicare Advantage Gold (HMO I-SNP), with Medicare-covered dental services requiring no copay and a 20% coinsurance. Other covered services, including exams, cleanings, and x-rays, feature no copay and no coinsurance, though fluoride, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from 0% (no coinsurance) to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Great Plain Medicare Advantage Gold (HMO I-SNP) with no copay and a 20% coinsurance. This coverage includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment and therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under Great Plain Medicare Advantage Gold (HMO I-SNP) are partially covered and require prior authorization, as lab services are not covered. Covered diagnostic procedures have a 20% coinsurance and no copay, while radiological services feature no coinsurance with copays of $10 for outpatient X-rays and a minimum of $50 for diagnostic and therapeutic radiology.
Home Health Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Great Plain Medicare Advantage Gold (HMO I-SNP) covers cardiac rehabilitation services with no copay and no coinsurance. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Great Plain Medicare Advantage Gold (HMO I-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $50 daily copay for days 21 to 100. A prior three-day inpatient hospital stay is required for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Great Plain Medicare Advantage Gold (HMO I-SNP) plan.
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