A non-government entity
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 2025, 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 2025.
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 $77.00. 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 $2150.00 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 Plain Medicare Advantage Gold (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 Plain Medicare Advantage Gold (HMO I-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay $10 for preferred generic drugs at a standard pharmacy, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Great Plain Medicare Advantage Gold (HMO I-SNP) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a $185 copay for the first 5 days, with no copay for the following days. Outpatient services, including specialist visits, mental health, and vision exams, have copays ranging from $20 to $50. The plan covers several services with coinsurance, including ambulance, dental, and durable medical equipment. Preventive services, home health, and skilled nursing facility stays (days 1-20) have no copay. The plan also provides coverage for hearing aids up to $2000 per year.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-5, you will pay a $185 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $50 copay, observation services with a $100 copay, and ambulatory surgical center (ASC) services with a $50 copay. Outpatient substance abuse services are covered with a copay of $30 for individual and group sessions, but outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Great Plain Medicare Advantage Gold (HMO I-SNP) plan. You will pay a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to a plan-approved health-related location. Ground ambulance services have a $150 copay, while air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Great Plain Medicare Advantage Gold (HMO I-SNP) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $30 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Great Plain Medicare Advantage Gold (HMO I-SNP) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay for routine care, Occupational Therapy Services, Physician Specialist Services with a $30 copay, and Mental Health Specialty Services with a $30 copay for individual and group sessions. The plan also covers Podiatry Services with 0-20% coinsurance for routine foot care (up to 6 visits per year), Other Health Care Professional, Psychiatric Services with a $30 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits with a $0-$30 copay, and Opioid Treatment Program Services.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit. However, the plan does not cover Annual Physical Exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and other services.
Hearing Services See details
Hearing Services are covered by the Great Plain Medicare Advantage Gold (HMO I-SNP) plan, including routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2000 per year, and prescription hearing aids (all types) are covered with no copay. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and coverage for eyewear, including contact lenses and eyeglasses (lenses and frames), with a maximum benefit of $100 for contact lenses and $275 for eyeglasses (lenses and frames) every year. Eyeglass lenses and frames are not covered.
Dental Services See details
The Great Plain Medicare Advantage Gold (HMO I-SNP) plan covers dental services with a 20% coinsurance. Oral exams and prophylaxis (cleaning) are covered, with 2 exams and cleanings allowed per year, while dental x-rays are covered once every 5 years. The plan does not cover fluoride treatments, implant services, adjunctive general services, or orthodontics. Orthodontic services are covered up to a maximum of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Great Plain Medicare Advantage Gold (HMO I-SNP) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts, each with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services are not covered. Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of at most $50, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Great Plain Medicare Advantage Gold (HMO I-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Great Plain Medicare Advantage Gold (HMO I-SNP) plan. While the plan covers some cardiac rehabilitation services, the specific services listed are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Great Plain Medicare Advantage Gold (HMO I-SNP) plan. You will have no copay for days 1-20, and a $100 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered under the Great Plain Medicare Advantage Gold (HMO I-SNP) plan. Specifically, 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, and self-directed personal assistance services are not covered.
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