Great Plains Medicare Advantage Gold (HMO I-SNP)
North Dakota Institutional Special Needs I-SNP Plan (2026 Plan)
by Great Plains Medicare Advantage
Additional Coverage
HearingVisionDental
Overall Government Star Rating
(coming soon)
Plan Name
Great Plains Medicare Advantage Gold (HMO I-SNP)
Insurance Carrier
Great Plains Medicare Advantage
Plan Type
Institutional Special Needs Plan (I-SNP)
Great Plains Medicare Advantage Gold (HMO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in North Dakota and offered by the health insurance company Great Plains Medicare Advantage. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$30 copay
Great Plains Medicare Advantage Gold (HMO I-SNP) has a monthly premium cost of $72 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $2,750 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Great Plains Medicare Advantage Gold (HMO I-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Great Plains Medicare Advantage Gold (HMO I-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Great Plains Medicare Advantage Gold (HMO I-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Great Plains Medicare Advantage Gold (HMO I-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $30 copay
Out-of-network: $30 copay
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $50 copay
Out-of-network: $50 copay
Outpatient x-rays
In-network: $10 copay
Out-of-network: $10 copay
Hospital Services
Inpatient hospital coverage
Tier 1
$185 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Outpatient hospital coverage
In-network: $50 copay
Out-of-network: $50 copay
Skilled nursing facility
Skilled nursing facility
Tier 1
$0 per day for days 1-20
$50 per day for days 21-100
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $150 copay
Out-of-network: $150 copay
Therapy services
Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $30 copay
Outpatient individual therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $30 copay
Outpatient group therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Outpatient individual therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic | $0.00 copay | $0 copay |
| Generic | $10.00 copay | $0 copay |
| Preferred Brand | $45.00 copay | $0 copay |
| Non-Preferred Drug | $95.00 copay | $0 copay |
| Specialty Tier | 33% coinsurance | $0 copay |
Part B Drugs
Chemotherapy drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Other Part B drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Hearing
Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - over the counter
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
Health Plan Radar