I-SNP Plan Costs & Benefits

Great Plains Medicare Advantage is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Great Plains Medicare Advantage does allow out-of-network care for emergencies and out-of-area dialysis.

Private health plans are not standardized. Out-of-pocket costs, including premiums, deductibles, and copays, widely vary. We recommend reviewing and comparing plan costs carefully.

Healthcare Service	Member Cost
Health plan deductible	$226 per year for in-network services.
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,300 In-network
Doctor Visits
Specialist	20% coinsurance per visit
Wellness programs (e.g., fitness, nursing hotline)	Not covered
Preventive care	$0 copay
Mental Health Services
Outpatient group therapy visit	20% coinsurance
Outpatient individual therapy visit	20% coinsurance
Inpatient hospital - psychiatric	In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per (authorization required)
Outpatient individual therapy visit with a psychiatrist	20% coinsurance
Rehabilitation Services
Occupational therapy visit	20% coinsurance
Medical Equipment / Supplies
Diabetes supplies	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Lab services	$0 copay (authorization required)
Outpatient x-rays	20% coinsurance (authorization required)
Diagnostic tests and procedures	20% coinsurance (authorization required)
Medicare Part B Drugs
Chemotherapy	20% coinsurance (authorization required)
Foot Care (podiatry Services)
Foot exams and treatment	20% coinsurance
Hearing
Hearing aids	$0 copay (limits may apply)
Hearing exam	20% coinsurance
Preventive Dental
Cleaning	$0 copay (limits may apply)
Dental x-ray(s)	$0 copay (limits may apply)
Fluoride treatment	Not covered
Comprehensive Dental
Periodontics	$0 copay (limits may apply)
Non-routine services	$0 copay (limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (limits may apply)
Extractions	$0 copay (limits may apply)
Diagnostic services	$0 copay (limits may apply)
Endodontics	$0 copay (limits may apply)
Vision
Contact lenses	$0 copay (limits may apply)
Routine eye exam	$0 copay (limits may apply)
Upgrades	$0 copay (limits may apply)
Other	Not covered
Eyeglasses (frames and lenses)	$0 copay (limits may apply)
Eyeglass lenses	Not covered
Emergency Care / Urgent Care
Urgent care	20% coinsurance per visit (always covered)
Ground ambulance	20% coinsurance
Inpatient hospital coverage	In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per
Outpatient hospital coverage	20% coinsurance per visit
Skilled Nursing Facility	In 2023 the amounts for each benefit period are: $0 copay for days 1 through 20 $200 copay per day for
Optional supplemental benefits	No

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that Great Plains Medicare Advantage covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

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.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. 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 has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

CMS Rating Marks

Each year the Centers for Medicare & Medicaid Services rates Medicare Advantage I-SNP's using nine broad categories. Medicare Wizard does not recommend enrolling in an SNP plan with an overall rating of less than 3.0. (3 out of 5 stars)

Do You Qualify to Join Great Plains Medicare Advantage?

You will need to meet three requirements to be eligible to join Great Plains Medicare Advantage:

1. You are eligible for Medicare;
2. You live in Grand Forks County, North Dakota; and
3. You need the level of care provided in an institutional environment, such as a long-term care nursing facility, for 90 days or more.

If you live at home and require skilled nursing care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).

If you don't qualify for Great Plains Medicare Advantage, or another Medicare Special Needs Plan in your area, Medicare Advantage plans available in Grand Forks County, North Dakota may be another option.

Contact Great Plains Medicare Advantage

The 2023 Medicare Special Needs Plans for Grand Forks County, North Dakota information on this page originates from Medicare.gov, is maintained by the All Medicare team, and was last updated on February 8, 2023.