Great Plains Medicare Advantage Gold (I-SNP) Costs & Coverage, Morton County, North Dakota
Great Plains Medicare Advantage Gold (I-SNP) Costs & Coverage, Morton County, North Dakota
Explore the benefits and costs of Great Plains Medicare Advantage Gold (I-SNP HMO), a 2025 Medicare Special Needs Plan designed to meet your unique healthcare needs. Dive into this detail page to see how this Great Plains Medicare Advantage SNP can support your specific health conditions or financial circumstances.
Available in Morton County, ND, to qualified residents, Great Plains Medicare Advantage Gold offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Plan ID H8967-002-0 Overview | |
---|---|
Health Plan ID: | H8967-002-0 |
Medicare Advantage Plan Type: | HMO |
Plan Year: | 2024 |
Monthly Premium: | $65.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced $0.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Morton County, ND |
Insured By: | Great Plains Medicare Advantage |
We're Here to Help You Enroll |
---|
Health Plan Cost Sharing & Benefits
Great Plains Medicare Advantage Gold is a Health Maintenance Organization (HMO) plan. As an HMO I-SNP member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Great Plains Medicare Advantage Gold does cover out-of-network care for emergencies and out-of-area dialysis.
Service | Enrollee Cost |
---|---|
Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $30 Copay |
Wellness & Preventive Programs: | |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | 20% Coinsurance |
Routine Foot Care: | $0 |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay |
Routine chiropractic: | $20 Copay |
Emergency and Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $30 Copay |
Ground ambulance: | $150 Copay |
Inpatient hospital care: | $185.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $50 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $100.00 per day for days 21 and beyond |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $30 Copay |
Outpatient group therapy: | $30 Copay |
Inpatient psychiatric hospital care: | $185.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $30 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $0 |
Occupational therapy: | $0 |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $50 Copay Prior Authorization Required |
Lab services: | $0 |
Outpatient x-rays: | $10 Copay Prior Authorization Required |
Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Supplemental Health Plan Benefits (H8967-002-0)
The following is a summary of the supplemental benefits Great Plains Medicare Advantage includes with this plan:
Supplemental Healthcare Service | Member Cost |
---|---|
Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Great Plains Medicare Advantage Gold includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $14.50 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $14.50 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Great Plains Medicare Advantage begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Great Plains Medicare Advantage Gold has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
---|---|---|
1 (Preferred Generic) | N/A | $4.00 copay |
2 (Generic) | N/A | $10.00 copay |
3 (Preferred Brand) | N/A | $45.00 copay |
4 (Non-Preferred Drug) | N/A | $95.00 copay |
5 (Specialty Tier) | N/A | 33% |
6 (Select Care Drugs) | N/A | $0.00 copay |
CMS Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage I-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Great Plains Medicare Advantage plan.
CMS Measure | Star Rating |
---|---|
2025 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
Managing Chronic (Long Term) Conditions | Not enough data available |
Member Experience with Health Plan | Not enough data available |
Complaints and Changes in Plans Performance | Not enough data available |
Health Plan Customer Service | Not enough data available |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | Not enough data available |
Member Experience with the Drug Plan | Not enough data available |
Drug Safety and Accuracy of Drug Pricing |
Eligibility for Enrollment in Great Plains Medicare Advantage Gold
To enroll in Great Plains Medicare Advantage Gold, you must meet the following three criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You require the level of care typically provided in an institutional setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and need a similar level of skilled care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before enrolling in Great Plains Medicare Advantage Gold, it’s important to consider the following questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I anticipate with this coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket expenses?
- Will I be able to continue seeing my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities conveniently located?
- Does the plan cover services I receive from out-of-network providers?
- Will I need a referral to visit a specialist?
- Are my medications included in the Part D plan's formulary?
- What special accommodations does the plan offer for individuals with disabilities?
- What language and cultural accommodations does the plan provide?
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for Great Plains Medicare Advantage Gold, it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
For comprehensive information on these enrollment periods, learn more here and make well-informed Medicare decisions.
Contact Great Plains Medicare Advantage
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://www.greatplainsmedicareadvantage.com |
---|---|
Formulay Information: | http://www.greatplainsmedicareadvantage.com |
Pharmacy Information: | Great Plains Medicare Advantage Pharmacy Page |
Prospective Members: | (877)701-0784 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.