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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 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 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 $72.00. 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 coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at a standard pharmacy. For Tier 2 generic medications, standard pharmacy copays are $10 for a one-month, $20 for a two-month, and $30 for a three-month supply. Tier 3 preferred brand drugs require standard pharmacy copays of $45 for a one-month, $90 for a two-month, and $105 for a three-month supply. Tier 4 non-preferred drugs cost $95 for one month, $190 for two months, and $285 for three months, while Tier 5 specialty drugs require a 33% coinsurance for all supply lengths. This straightforward copay and coinsurance structure helps you easily estimate your prescription costs with this plan.
Additional Benefits
The Great Plains Medicare Advantage Gold (HMO I-SNP) offers comprehensive medical coverage with no copay for primary care, physical therapy, and home health services. Inpatient hospital stays require a $185 daily copay for the first five days and no copay for days six through 90, while skilled nursing facilities have no copay for the first 20 days. Specialist visits, urgent care, and partial hospitalization each carry a $30 copay, and outpatient hospital services require a $50 copay. Additional benefits include no-copay routine dental and hearing services, featuring a $2,000 annual limit for both preventive dental care and prescription hearing aids. Vision benefits provide a $30 routine exam copay alongside annual allowances of $275 for eyeglasses and $100 for contact lenses. Members also benefit from 32 free one-way transportation trips per year, while durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
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 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers outpatient hospital and ambulatory surgical center services with a $50 copay and no coinsurance, and observation services with a $100 copay per stay and no coinsurance. Outpatient substance abuse services require a $30 copay with no coinsurance, while outpatient blood services have no copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Great Plains Medicare Advantage Gold (HMO I-SNP) with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 32 one-way trips per year to plan-approved locations, though 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. Both copays are waived if you are admitted to the hospital within three days, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers primary care, occupational therapy, physical therapy, and opioid treatment with no copay and no coinsurance. Specialist visits, mental health, and psychiatric services require a $30 copay and no coinsurance, while chiropractic services are partially covered (excluding other chiropractic services) with a $20 to $30 copay and podiatry services have no copay and 0% to 20% coinsurance.
Preventive Services See details
Preventive services are covered under the Great Plains Medicare Advantage Gold (HMO I-SNP) with no copay and no coinsurance, including kidney disease education, glaucoma screenings, and diabetes self-management training. However, annual physical exams and additional preventive services—including health education, fitness benefits, and in-home safety assessments—are not covered.
Hearing Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) covers hearing services with a $30 copay and no coinsurance for exams, alongside prescription hearing aids with no copay or coinsurance up to a $2,000 annual limit. This benefit is partially covered, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) partially covers vision services with no deductibles, offering one annual routine eye exam for a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance, providing up to $100 annually for contact lenses and $275 annually for eyeglasses (lenses and frames), though individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Great Plains Medicare Advantage Gold (HMO I-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance, and other covered preventive and comprehensive services having no copay and no coinsurance up to a $2,000 annual maximum. Fluoride treatments, maxillofacial prosthetics, orthodontics, other diagnostic services, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Great Plains Medicare Advantage Gold (HMO I-SNP) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, insulin, and other drugs, carry a coinsurance ranging from no coinsurance up to 20%, with insulin services also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Great Plains Medicare Advantage Gold (HMO I-SNP) plan 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 and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under the Great Plains Medicare Advantage Gold (HMO I-SNP) are partially covered, as lab services are not covered. Covered diagnostic procedures require a 20% coinsurance and no copay, while radiological services have no coinsurance and require copayments of $10 for outpatient X-rays and $50 for diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Great Plains Medicare Advantage Gold (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Great Plains Medicare Advantage Gold (HMO I-SNP) provides cardiac rehabilitation services with no coinsurance, meaning some services are covered, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by the plan.
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. There is no copay for days 1 through 20 and a $50 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the Great Plains Medicare Advantage Gold (HMO I-SNP) plan, as supplemental benefits such as acupuncture, over-the-counter (OTC) items, and meal benefits are not available.
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