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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 Nebraska (partial). This plan received an overall rating of 4 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 $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $50.60. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Great Plains Medicare Advantage (HMO I-SNP) plan provides coverage for a variety of services. This plan covers inpatient hospital stays, outpatient services, partial hospitalization, ambulance and transportation, emergency services, and primary care services. You will typically pay a coinsurance of 20% for many services, but some services have a copay, such as emergency services at $90. The plan also offers coverage for preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility services. Hearing exams and prescription hearing aids are covered, with a maximum of $2000 per year. Vision benefits include routine eye exams, contact lenses, and eyeglasses.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan, but additional days, non-Medicare covered stays, and upgrades for inpatient hospital-acute and additional days and non-Medicare covered stays for inpatient hospital psychiatric are not covered. Cost sharing details, including coinsurance, are available.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a 20% coinsurance, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse all have a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by 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 by the Great Plains Medicare Advantage (HMO I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, with no copay. Transportation Services to a plan-approved health-related location are covered for 28 one-way trips per year, using rideshare services, van, medical transport, or other methods; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $90 copay and no coinsurance, and Urgently Needed Services are covered with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Great Plains Medicare Advantage (HMO I-SNP) plan covers primary care physician services, chiropractic services with 20% coinsurance, occupational therapy services with 20% coinsurance, physician specialist services with 20% coinsurance, mental health specialty services with 20% coinsurance, podiatry services with 20% coinsurance, other health care professional services with 20% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits with 0-20% coinsurance, and opioid treatment program services. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, as well as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, and many other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $2000 every year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids 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, one pair of contact lenses per year with a maximum benefit coverage amount of $100, and one pair of eyeglasses (lenses and frames) per year with a maximum benefit coverage amount of $380; however, eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Other dental services include coverage for oral exams (2 per year), dental x-rays (1 every 5 years), prophylaxis/cleaning (2 per year), restorative services, endodontics, periodontics, maxillofacial prosthetics, prosthodontics (removable - 1 visit, every 2 years), and prosthodontics (fixed - 1 visit, every 2 years), while fluoride treatment, implant services, and orthodontics are not covered.
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. The plan has a $35 copay for Medicare Part B Insulin Drugs with a coinsurance between 0% and 20% for all covered drugs.
Dialysis Services See details
Dialysis Services are covered by the Great Plains Medicare Advantage (HMO I-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Great Plains Medicare Advantage (HMO I-SNP) plan. Durable Medical Equipment (DME) and Diabetic Supplies have a 20% coinsurance, while Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance; there is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services 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, 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 Plains Medicare Advantage (HMO I-SNP) plan. Though the plan covers some Cardiac Rehabilitation Services, it does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan. However, additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Great Plains Medicare Advantage (HMO I-SNP) plan, including acupuncture, over-the-counter items, meal benefits, and other services. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and others are also not covered.
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