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Great Plains Medicare Advantage

South Dakota

Great Plains Medicare Advantage (HMO I-SNP) and Great Plains Medicare Advantage Gold (HMO I-SNP) are Institutional Special Needs Plans (I-SNP) that provides outstanding and personalized care for their members. The health plans cover all Original Medicare benefits (Part A and B), prescription drugs (Part D), and many other supplemental benefits such as routine foot care and routine eye exams. In addition, each member receives a specially designed care plan, implemented by their nurse-practitioner-led care team. If you or your loved one is eligible, Great Plains Medicare Advantage could be the extra benefit you need to enhance your well-being.

Membership advantages include:

  • A personalized care plan
  • Medicare Part D Prescription Drug Coverage
  • Routine vision, hearing, foot care and dental – plus preventative services and screenings
  • A Nurse Practitioner who will visit your facility regularly to provide treatment and help avoid unwanted trips to the hospital
  • Communication and coordination of your care between you, your family, your Nurse Practitioner and doctors, and the skilled nursing facility staff

You have choices with Great Plains Medicare Advantage

You are eligible to join Great Plains Medicare Advantage Plan if you have Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and meet Great Plains Medicare Advantage’s eligibility requirements.

Great Plains Medicare Advantage I-SNP

Great Plains Medicare Advantage Plan Institutional Special Needs Plan is best suited for people who, for 90 days or longer, have had or are expected to need institutionalized care, as determined by the state in one of our participating nursing facilities.

Great Plains Medicare Advantage I-SNP GOLD

Great Plains Medicare Advantage Gold is best suited for people who want lower out of pocket costs and, as determined by the state in one of our participating nursing facilities, plan to live in institutionalized care or are expected to need institutionalized care for 90 days or longer.

Benefit Highlights

2022 I-SNP Benefit Highlights

How much is the monthly premium?

$38.90 per month. You also must keep paying your Medicare Part B premium.

How much is the deductible?

$203 per year for in-network services.
$480 per year for Part D prescription drugs.

Is there any limit on how much I will pay for covered services?

Yes, similarly to all Medicare plans, we protect you by establishing a maximum amount that you will pay out of pocket for covered services. The yearly Maximum Out-Of-Pocket Cost is $5,900.

After reaching this limit, the plan will pay for all covered services and procedures. Please note: you will still have to pay your monthly premiums and cost-sharing for Part D prescription drugs.

Is there a limit on how much the plan will pay?

The plan does have a yearly coverage limit for certain in-network benefits. Please contact us for more information.

Below is a list of all the supplemental benefits that our plan provides. These benefits are in addition to all benefits received under Original Medicare.

Benefits Coverage
Primary Care Physician (PCP) Visit $0 Copay for in-room and office visits
On-site customized care team Regular personalized on-site visits, plus direct member access and care coordination
Podiatry $0 Copay for 6 routine foot care visits per year
Hearing $0 Copay for routine hearing exam, hearing aid fitting, and up to $2,000 for hearing aids every two years
Vision $0 Copay for routine eye exam + up to $330 for eyewear every year
Dental $0 Copay for routine hearing exam, hearing aid fitting twice per year, and up to $1,500 every 2 years for dentures, PLUS $500 for comprehensive services
Skilled Nursing No prior hospitalization required for a skilled nursing stay
Non-emergency Transportation $0 Copay for 24 one-way trips per year for non-emergency health services
Prescription Drugs Prescription drug coverage, plus pharmacy coordination and monitoring

2022 I-SNP Gold Benefit Highlights

How much is the monthly premium?

$50.00 per month. You also must keep paying your Medicare Part B premium

How much is the deductible?

$0 per year for in-network services.
$0 per year for Part D prescription drugs.

Is there any limit on how much I will pay for covered services?

Yes, similarly to all Medicare plans, we protect you by establishing a maximum amount that you will pay out of pocket for covered services.

  • The yearly Maximum Out-Of-Pocket Cost is $3,000.

After reaching this limit, the plan will pay for all covered services and procedures. Please note: you will still have to pay your monthly premiums and cost-sharing for Part D prescription drugs.

Is there a limit on how much the plan will pay?

The plan does have a yearly coverage limit for certain in-network benefits. Please contact us for more information.

Below is a list of all the supplemental benefits that our plan provides. These benefits are in addition to all benefits received under Original Medicare.

Benefits Coverage
Primary Care Physician (PCP) Visit $0 Copay
On-site customized care team Regular personalized on-site visits, plus direct member access and care coordination
Inpatient Hospitalization You only pay $185 per day for days 1-5 and $0 per day for days 6-90 for inpatient hospitalization + 60 lifetime reserve days
Rehabilitative Therapists $0 Copay for occupational, physical, and speech therapy services
Podiatry $0 Copay for 6 routine foot care visits per year
Hearing $0 Copay for routine hearing exam, hearing aid fittings and up to $2,000 for hearing aids every two years
Vision $0 Copay for routine eye exam and up to $275 for eyewear every year
Dental $0 Copay for routine hearing exam, hearing aid fitting twice per year, and up to $1,500 every 2 years for dentures, PLUS $500 for comprehensive services
Skilled Nursing No prior hospitalization required for a skilled nursing stay
Non-Emergency Transportation $0 Copay for 24 one-way trips per year for non-emergency health services.
Enhanced Part D Copays as low as $4 for a one-month supply
Maximum Enrollee Out-of-Pocket Cost $3,000 per plan year – We pay 100% of cost after you spend $3,000 on Part A and Part B services.

Member Part D Prescription Drug Benefits

2022 I-SNP Part D Prescription Drug Benefits

Below is a brief summary of benefits. For a complete list of benefits and other resources, please review your Evidence of Coverage.

How much do I pay?

For Part B drugs such as chemotherapy drugs: 25% of the cost
Other Part B drugs: 25% of the cost

Initial Coverage

After you pay your yearly deductible, you pay 25% of the cost for all drugs covered by this plan until your total yearly drug costs reach $4,430. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.

You may get your drugs at network retail pharmacies.

If you reside in a long-term care facility, you pay the same as at a retail pharmacy. You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy

Coverage Gap

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,430.

After you enter the coverage gap, you pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $7,050, which is the end of the coverage gap. Not everyone will enter the coverage gap.

Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050, you pay the greater of:

  • 5% of the cost, or
  • $3.95 copay for generic (including brand drugs treated as generic) and a $9.85 copayment for all other drugs.

2022 I-SNP Gold Part D Prescription Drug Benefits

Below is a brief summary of benefits. For a complete list of benefits and other resources, please review your Evidence of Coverage.

How much do I pay?

For Part B drugs such as chemotherapy drugs: 25% of the cost
Other Part B drugs: 25% of the cost

Initial Coverage

There is no deductible for your Part D plan.

Prior to reaching the Initial Coverage limit ($4,430), your Part D Plan follows a five-tier formulary with categories as follows:

$480 for Tier 2, Tier 3, Tier 4, and Tier 5 Part D prescription drugs. For all other drugs, you will not have to pay any deductible and will start receiving coverage immediately.

Tier 1: Preferred Generic
Tier 2: Generic
Tier 3: Preferred Brand
Tier 4: Non-Preferred Brand
Tier 5: Specialty Tier

The copayments for those categories follow the following structure:

Tier 1: $4
Tier 2: $10
Tier 3: $45
Tier 4: $95
Tier 5: 33%

Coverage Gap

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,430.

After you enter the coverage gap, you pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $7,050, which is the end of the coverage gap. Not everyone will enter the coverage gap.

Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050, you pay the greater of:

  • 5% of the cost, or
  • $3.95 copay for generic (including brand drugs treated as generic) and a $9.85 copayment for all other drugs.

If you have questions or want to request additional information, please call Member Services at 1-844-637-4760 (TTY 888-279-1549). Calls to this number are free.

Want more information about Great Plains Medicare Advantage?

Call us at 1-844-637-4760 (TTY 888-279-1549). Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m., or fill out this contact me form to have us call you.

Contact Me Form

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