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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 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 North Dakota (partial). The overall rating for this plan is not yet available for 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 $41.50. 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 $8315.00 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 features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before the plan begins to cover its share of your prescription costs. Specific drug coverage tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To fully understand your potential out-of-pocket expenses, it is best to consult the plan's formulary to see how your specific medications are covered.
Additional Benefits
Great Plains Medicare Advantage (HMO I-SNP) offers comprehensive medical coverage, featuring no copay and no coinsurance for inpatient hospital stays and primary care visits. Specialist visits, outpatient services, diagnostic tests, and durable medical equipment generally require no copay and a 20% coinsurance. Emergency care is available with a $90 copay, while urgent care has no copay and a 20% coinsurance up to $40, with both fees waived if you are admitted to the hospital. The plan also provides valuable supplemental benefits, including home health services with no copay or coinsurance, and up to 40 one-way transportation trips per year to approved locations. Routine dental, vision, and hearing exams are covered with no copay and a 20% coinsurance, alongside generous allowances like up to $2,000 annually for dental care and $2,000 for prescription hearing aids. Eyewear is also covered with no copay or coinsurance, offering up to $100 yearly for contact lenses and $300 yearly for eyeglasses.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Great Plains Medicare Advantage (HMO I-SNP), offering acute and psychiatric stays with no copay and no coinsurance, subject to Medicare-defined cost shares. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Great Plains Medicare Advantage (HMO I-SNP) outpatient services generally require a 20% coinsurance and no copay for ambulatory surgical center visits, outpatient substance abuse sessions, and blood services. Medicare-covered hospital observation services require a $100 copay per stay, and prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Great Plains Medicare Advantage (HMO I-SNP) covers partial hospitalization services 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, offering up to 40 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, but 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, with both fees 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 Plains Medicare Advantage (HMO I-SNP) covers primary care physician and opioid treatment services with no copay and no coinsurance, while telehealth services feature no copay and 0% to 20% coinsurance. Most other services, including specialist visits, mental health, therapies, and routine podiatry, have no copay and 20% coinsurance, though chiropractic benefits are only partially covered since other non-routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Great Plains Medicare Advantage (HMO I-SNP), with Medicare-covered preventive services, kidney disease education, and screenings like glaucoma and diabetes self-management offered with no copay and no coinsurance. However, several sub-services are not covered under this plan, including the annual physical exam, fitness benefits, health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers hearing services with no copay and a 20% coinsurance for routine hearing exams, which are limited to one per year. Prescription hearing aids are covered up to a $2,000 annual maximum with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Great Plains Medicare Advantage (HMO I-SNP) with no deductibles, offering one routine eye exam per year with no copay and a 20% coinsurance. Eyewear is covered with no copay and no coinsurance, providing up to $100 yearly for contact lenses and $300 yearly for eyeglasses (lenses and frames), though other eye exams, individual eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Great Plains Medicare Advantage (HMO I-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for most other covered services up to a $2,000 annual limit. Sub-services that are not covered under this plan include other diagnostic services, fluoride treatment, other preventive services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Great Plains Medicare Advantage (HMO I-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry 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
Dialysis Services are covered by Great Plains Medicare Advantage (HMO I-SNP) 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, and the plan does not restrict coverage to specific manufacturers or vendors.
Diagnostic and Radiological Services See details
Great Plains Medicare Advantage (HMO I-SNP) partially covers diagnostic and radiological services with prior authorization, requiring no copay and a 20% coinsurance for covered services. While outpatient diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays are covered, laboratory services are not covered under this plan.
Home Health Services See details
Home Health Services are covered under Great Plains Medicare Advantage (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Great Plains Medicare Advantage (HMO I-SNP) with no copay, but in practice only 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 and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Great Plains Medicare Advantage (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay, though Medicare-defined cost-sharing applies. This benefit is partially covered, as a prior three-day inpatient hospital stay is required and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Great Plains Medicare Advantage (HMO I-SNP) indicates that some services are covered under its other services benefit, but acupuncture, over-the-counter (OTC) items, meal benefits, and highly integrated services for dual eligible SNPs are not covered.
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