Great Plains Medicare Advantage (HMO I-SNP) By Great Plains Medicare Advantage



Great Plains Medicare Advantage (HMO I-SNP) H1787 001 0 is a 2023 Medicare Advantage Special Needs Plan plan by Great Plains Medicare Advantage. This plan from Great Plains Medicare Advantage works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Great Plains Medicare Advantage and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Great Plains Medicare Advantage (HMO I-SNP) H1787-001 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursing home or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.







2023 Medicare Special Needs Plan Details

Plan Name:Great Plains Medicare Advantage (HMO I-SNP)
Plan ID:H1787 001 0
Special Needs Type:Institutional
Provider:Great Plains Medicare Advantage
Plan Year:2023
Plan Type:Local HMO
Monthly Premium C+D:$39.90
Part C Premium:$0
Part D (Drug) Premium:$39.90
Part D Supplemental Premium$0
Total Part D Premium:$39.90
Drug Deductible:$505.00
Tiers with No Deductible:0
Benchmark:below the regional benchmark
Type of Medicare Health Plan:Defined Standard Benefit
Drug Benefit Type:Basic
Gap Coverage:No
Similar Plan: H1787-002


The Great Plains Medicare Advantage (HMO I-SNP) H1787-001 is available to residents to Medicare eligible seniors in South Dakota. All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Great Plains Medicare Advantage (HMO I-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.



How much does Great Plains Medicare Advantage (HMO I-SNP) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Great Plains Medicare Advantage charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Great Plains Medicare Advantage (HMO I-SNP) has a monthly drug premium of $39.90 and a $505.00 drug deductible. This Great Plains Medicare Advantage plan offers a $39.90 Part-D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Great Plains Medicare Advantage above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $39.90. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


Great Plains Medicare Advantage Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Great Plains Medicare Advantage plan does not offer additional coverage through the gap.


Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Great Plains Medicare Advantage (HMO I-SNP) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $10.00 for 75% low-income subsidy $20.00 for 50% and $29.90 for 25%.


Full Assistance Premium:$0
75% Assistance Premium:$10.00
50% Assistance Premium:$20.00
25% Assistance Premium:$29.90


H1787-001 Formulary and Drug Coverage

Great Plains Medicare Advantage (HMO I-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Special Needs Plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA 25%
Tier 2 NA 25%
Tier 3 NA 25%
Tier 4 NA 25%
Tier 5 NA 25%
The complete Great Plains Medicare Advantage (HMO I-SNP) H1787-001 Formulary
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits

The benefit information provided is a summary of what Great Plains Medicare Advantage (HMO I-SNP) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Great Plains Medicare Advantage helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Not covered



Contact lenses


Vision$0 copay



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


Vision$0 copay



Other


VisionNot covered



Routine eye exam


Vision$0 copay



Upgrades


Vision$0 copay




Transportation$0 copay
Skilled Nursing FacilityIn 2023 the amounts for each benefit period are:
$0 copay for days 1 through 20
$200 copay per day for days 21 through 100



Occupational therapy visit


Rehabilitation services20% coinsurance



Physical therapy and speech and language therapy visit


Rehabilitation services20% coinsurance



Cleaning


Preventive dental$0 copay



Dental x-ray(s)


Preventive dental$0 copay



Fluoride treatment


Preventive dentalNot covered



Oral exam


Preventive dental$0 copay




Preventive care$0 copay
Outpatient hospital coverage20% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health servicesIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90



Outpatient group therapy visit


Mental health services20% coinsurance



Outpatient group therapy visit with a psychiatrist


Mental health services20% coinsurance



Outpatient individual therapy visit


Mental health services20% coinsurance



Outpatient individual therapy visit with a psychiatrist


Mental health services20% coinsurance



Chemotherapy


Medicare Part B drugs20% coinsurance



Other Part B drugs


Medicare Part B drugs20% coinsurance



Diabetes supplies


Medical equipment/supplies20% coinsurance per item



Durable medical equipment (e.g., wheelchairs, oxygen)


Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,300 In-network
Inpatient hospital coverageIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90



Fitting/evaluation


Hearing$0 copay



Hearing aids


Hearing$0 copay



Hearing exam


Hearing20% coinsurance




Health plan deductible$226 per year for in-network services.
Ground ambulance20% coinsurance



Foot exams and treatment


Foot care (podiatry services)20% coinsurance



Routine foot care


Foot care (podiatry services)$0 copay



Emergency


Emergency care/Urgent care$90 copay per visit (always covered)



Urgent care


Emergency care/Urgent care20% coinsurance per visit (always covered)



Primary


Doctor visits$0 copay



Specialist


Doctor visits20% coinsurance per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging20% coinsurance



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging20% coinsurance



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging20% coinsurance



Diagnostic services


Comprehensive dental$0 copay



Endodontics


Comprehensive dental$0 copay



Extractions


Comprehensive dental$0 copay



Non-routine services


Comprehensive dental$0 copay



Periodontics


Comprehensive dental$0 copay



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dental$0 copay



Restorative services


Comprehensive dental$0 copay




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Special Need Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Great Plains Medicare Advantage (HMO I-SNP) requires you to live in that plan’s service area. The service area is listed below:





Source: CMS.

Plans as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2023 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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MedicareHelp.org is a privately-owned Non-governmental agency operated by Mark Spencer. The government website can be found at HealthCare.gov.

HealthCompare Insurance Services, HealthPlanOne, LLC, ClearMatch Medicare and Medicare Solutions does not offer every plan available in your area. Currently HealthCompare Insurance Services represent 18 organizations, which offers 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. HealthCompare Insurance Services, HealthPlanOne, LLC, ClearMatch Medicare and Medicare Solutions represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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