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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 2025, 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 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 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 $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:
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Drug Coverage
The Great Plains Medicare Advantage Gold (HMO I-SNP) plan has a $0 deductible. During the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier. For example, you'll pay a $10 copay for a preferred generic drug at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Great Plains Medicare Advantage Gold (HMO I-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $185 copay for days 1-5 and no copay for days 6-90, while outpatient services have copays ranging from $30 to $100. The plan also covers ambulance services with a $150 copay for ground transport and 20% coinsurance for air transport, as well as primary care, hearing, vision, and dental services with associated copays and coinsurance. Additional benefits include coverage for home health services with no copay, and skilled nursing facility stays with no copay for days 1-20. There is also coverage for medical equipment and diagnostic services with coinsurance up to 20%, as well as prescription hearing aids with a maximum benefit of $2,000 per year. However, some services like cardiac rehabilitation, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $185 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Great Plains Medicare Advantage Gold (HMO I-SNP) plan, including outpatient hospital services with a $50 copay, observation services with a $100 copay, and ambulatory surgical center services with a $50 copay. Outpatient substance abuse services are covered with a $30 copay for both individual and group sessions, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Great Plains Medicare Advantage Gold (HMO I-SNP) plan, with a $30 copay. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Great Plains Medicare Advantage Gold (HMO I-SNP) plan. Ground ambulance services have a $150 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 32 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services, the copay is $90 with no coinsurance, while Urgently Needed Services have a $30 copay with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Great Plains Medicare Advantage Gold (HMO I-SNP) plan covers primary care physician services, chiropractic services with a $20 copay for routine care, occupational therapy, physician specialist services with a $30 copay, mental health specialty services with a $30 copay for individual and group sessions, podiatry services with 0-20% coinsurance for routine foot care (up to 6 visits per year), other health care professional services with a copay of $30, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay or coinsurance, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services.
Preventive Services See details
Preventive Services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $30 copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a combined maximum benefit of $2000 every year, but prescription hearing aids for the inner, outer, and over-the-ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
The Great Plains Medicare Advantage Gold (HMO I-SNP) plan covers vision services, including eye exams with a $30 copay, and eyewear. The plan covers one pair of contact lenses per year with a maximum benefit of $100, and one pair of eyeglasses (lenses and frames) per year with a maximum benefit of $275. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other Dental Services include oral exams (2 per year), dental x-rays (1 every 5 years), and prophylaxis (cleaning) (2 per year), but fluoride treatment and implant services are not covered. Orthodontic services have a maximum benefit of $2,000 per year. Restorative services, endodontics, periodontics, maxillofacial prosthetics are covered, while adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Great Plains Medicare Advantage Gold (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Great Plains Medicare Advantage Gold (HMO I-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes/inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Great Plains Medicare Advantage Gold (HMO I-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of $50, and Outpatient X-Ray Services have a copay of $10.
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, but prior 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 Gold (HMO I-SNP) plan. There is a copay for some cardiac and pulmonary rehabilitation services, but all services are listed as not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Great Plains Medicare Advantage Gold (HMO I-SNP) plan, with no copay for days 1-20, and a $100 copay for days 21-100. 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 Gold (HMO I-SNP) plan, including acupuncture, over-the-counter items, meal benefits, and more. None of the listed sub-services are covered.
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