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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 North Dakota (partial). The overall rating for this plan is not yet available for 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 deductible for prescription drugs. After the deductible is met, you will pay the costs for your prescriptions, but the specific costs for each drug tier are not provided in this summary. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $50.60 per month for Part D coverage. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Great Plains Medicare Advantage (HMO I-SNP) plan offers coverage for a variety of services with varying cost-sharing. You'll have a $90 copay for emergency services, and a $100 copay for observation services. Many services such as outpatient, primary care, hearing, vision, dental, medical equipment, and dialysis services, will have a coinsurance of at most 20%. Preventive services and home health services have no copay or coinsurance. The plan also offers coverage for hearing aids up to $2000 per year, and vision services including eyewear. However, some services like Cardiac Rehabilitation and Other Services are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. However, additional days, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a 20% coinsurance, and observation services with a $100 copay per stay. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are also covered with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Great Plains Medicare Advantage (HMO I-SNP) plan, with a copay of $30.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation Services to a plan-approved health-related location are covered for 28 one-way trips every year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Great Plains Medicare Advantage (HMO I-SNP) plan with a $90 copay and no coinsurance, and Urgently Needed Services are covered with 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care benefits include coverage for 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 for routine foot care, 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 services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, while annual physical exams, health education, and several other services are not covered. There is no copay or coinsurance for these services, and no referrals are required.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids (all types) are covered, with a plan-specified amount of $2000 per year. Prescription hearing aids - Inner Ear, Outer Ear, and Over the Ear 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. The plan also covers eyewear, with a maximum coverage amount for contact lenses of $100 every year (1 pair), and for eyeglasses (lenses and frames) of $300 every year (1 pair). Eyeglass lenses and frames are not covered.
Dental Services See details
The Great Plains Medicare Advantage (HMO I-SNP) plan covers Medicare Dental Services with 20% coinsurance. Other dental services include Oral Exams (2 visits per year), Dental X-Rays (1 visit every 5 years), Prophylaxis (Cleaning) (2 visits per year), Restorative Services, Endodontics, Periodontics, Maxillofacial Prosthetics, and Prosthodontics, fixed, all with no coinsurance; however, Fluoride Treatment, Implant Services, and Orthodontics are not covered, and Prosthodontics, removable has a $1,500 limit every two years, and Oral and Maxillofacial Surgery is limited to 1 visit 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 and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
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 benefits are covered by the Great Plains Medicare Advantage (HMO I-SNP) plan, including Durable Medical Equipment (DME), with a 20% coinsurance and authorization required, while DME for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment are also covered, with a 20% coinsurance for Medicare-covered Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan. 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; all diagnostic and radiological services require prior authorization.
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 additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Great Plains Medicare Advantage (HMO I-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Great Plains Medicare Advantage (HMO I-SNP) plan, with coinsurance costs as defined by Medicare. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Great Plains Medicare Advantage (HMO I-SNP) plan. Specifically, acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and more are not covered.
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