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Great Plains Medicare Advantage Gold (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Great Plains 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 Plains Medicare Advantage Gold (HMO I-SNP) in 2026, please refer to our full plan details page.
Great Plains 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 Nebraska (partial). This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Great Plains 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 Plains 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 Plains 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 Plains Medicare Advantage Gold (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $73.00. 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 Plains Medicare Advantage Gold (HMO I-SNP) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) prescriptions filled at standard pharmacies. For Tier 2 (Generic) drugs, standard pharmacy copays are $9 for a 1-month supply, $18 for a 2-month supply, and $27 for a 3-month supply. For brand-name and specialty medications, standard pharmacy copays for Tier 3 (Preferred Brand) drugs are $45 for a 1-month supply, $90 for 2 months, and $135 for 3 months. Tier 4 (Non-Preferred) drugs cost $95, $190, or $285 depending on the supply duration, while Tier 5 (Specialty Tier) medications require a 33% coinsurance. This structured pricing helps you easily anticipate your out-of-pocket prescription expenses.
Additional Benefits
The Great Plains Medicare Advantage Gold (HMO I-SNP) plan offers comprehensive coverage for essential medical needs, including primary care visits, physical therapy, and home health services with no copay and no coinsurance. For inpatient hospital stays, members pay a $185 copay per day for the first five days and no copay for days six through 90, while specialist visits and urgent care services require a $30 copay. Outpatient hospital services feature a $50 copay, and emergency room visits carry a $90 copay that is waived if you are admitted to the hospital within three days. Routine vision and hearing exams are available for a $30 copay, while prescription hearing aids and select eyewear are covered with no copay. Medicare-covered dental services, durable medical equipment, and dialysis are covered with no copay and a 20% coinsurance. Skilled nursing facility stays feature no coinsurance, requiring no copay for the first 20 days and a $50 daily copay for days 21 through 100.
Inpatient Hospital See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $185 copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers outpatient services, featuring a $50 copay and no coinsurance for both outpatient hospital and ambulatory surgical center services. Observation services require a $100 copay per stay with no coinsurance, outpatient substance abuse sessions have a $30 copay with no coinsurance, and outpatient blood services carry no copay with a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Great Plains Medicare Advantage Gold (HMO I-SNP) with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Great Plains Medicare Advantage Gold (HMO I-SNP), with ground ambulance services requiring a $150 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 32 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Great Plains 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 you are admitted to the hospital within 3 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 Plains Medicare Advantage Gold (HMO I-SNP) covers primary care, occupational, physical, and speech therapies, and opioid treatment with no copay and no coinsurance. Specialist, mental health, and psychiatric services require a $30 copay and no coinsurance, while telehealth services range from a $0 to $30 copay and no coinsurance. Chiropractic care is partially covered, excluding other chiropractic services, with a $20 to $30 copay and no coinsurance, and podiatry features no copay except for routine foot care, which has a 0% to 20% coinsurance.
Preventive Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) offers partially covered preventive services with no copay and no coinsurance for Medicare-covered preventive care, kidney disease education, and diabetes self-management. Annual physical exams are not covered, and though some additional preventive services are covered in theory, specific options like fitness benefits, health education, in-home support, and personal emergency response systems are excluded.
Hearing Services See details
Hearing services are partially covered by Great Plains Medicare Advantage Gold (HMO I-SNP), featuring routine hearing exams for a $30 copay and no coinsurance, and prescription hearing aids up to $2,000 annually with no copay and no coinsurance. OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Great Plains Medicare Advantage Gold (HMO I-SNP), which offers routine eye exams for a $30 copay and no coinsurance, and eyewear with no copay and no coinsurance. Covered eyewear includes annual contact lenses up to $100 and eyeglasses up to $275, while other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental 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
Great Plains Medicare Advantage Gold (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Great Plains Medicare Advantage Gold (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, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Great Plains Medicare Advantage Gold (HMO I-SNP), as lab services are not covered. Covered diagnostic procedures require prior authorization, a 20% coinsurance, and no copay, while radiological services require prior authorization, no coinsurance, and copayments of $10 for X-rays and a minimum of $50 for diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Great Plains Medicare Advantage Gold (HMO I-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services feature no coinsurance under the Great Plains Medicare Advantage Gold (HMO I-SNP) plan, but the benefit is not covered in practice because all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Great Plains Medicare Advantage Gold (HMO I-SNP) with no coinsurance, requiring a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, and a $50 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Other services are not covered under the Great Plains Medicare Advantage Gold (HMO I-SNP) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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