Great Plains Medicare Advantage (HMO I-SNP)
Nebraska Institutional Special Needs I-SNP Plan (2024 Plan)
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Additional Coverage
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Plan Overview
Great Plains Medicare Advantage (HMO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in Nebraska 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.
Cost Summary
Great Plains Medicare Advantage (HMO I-SNP) has a monthly premium cost of $31 per month, with an annual deductible of $240 per year for in-network services. and a maximum out of pocket cost sharing of $8,850 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 (HMO I-SNP) are defined below.
Additional Benefits and Coverage
Great Plains Medicare Advantage (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 (HMO I-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Great Plains Medicare Advantage (HMO I-SNP) includes coverage for the following additional benefits:
Other benefits
Plan Benefits and Coverage Details
Medical Benefits
Doctor Services
Tests, labs, & imaging
Hospital Services
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Skilled nursing facility
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Preventive services
Ambulance
Therapy services
Mental health services
Opioid treatment services
Other services
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic |
Brand-name drugs :
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Brand-name drugs :
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| Generic | |||
| Preferred Brand | |||
| Non-Preferred Drug | |||
| Specialty Tier |
Part B Drugs
Extra Benefits
Hearing
Preventive Dental
Comprehensive dental
Vision
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