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Great Plain Medicare Advantage Gold (I-SNP) Plan Details for Turner County, SD

This page provides coverage and cost details for Great Plains Medicare Advantage’s H1787-002-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.

CMS 2025 Rating: ☆☆☆☆☆*

*This plan is new and has not yet been rated by CMS.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Great Plains Medicare Advantage logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.

Individuals must meet all Institutional SNP qualification requirements to join this I-SNP plan.

Great Plain Medicare Advantage Gold Basic Plan Details

Plan ID
H1787-002-0
Plan Type
HMO I-SNP
Plan Year
2025
Premium
$77.00/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
2,150.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Enhanced
$0.00 deductible
Supplemental Benefits
Vision, Hearing
Availability
Turner County, SD
Insured By
Great Plains Medicare Advantage
Summary of Benefits

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Health Plan Out-of-Pocket Costs

The following table is a summary of the most common out-of-pocket costs you will incur if you join this Great Plains Medicare Advantage plan:

Doctor's Office Visits

Primary
Not Covered
Specialist
$30 Copay

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
$90 Copay
Urgent care
$30 Copay
Ground ambulance
$150 Copay
Inpatient hospital care
$185.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond
Skilled Nursing Facility
$0.00 per day for days 1 through 20
$100.00 per day for days 21 and beyond

Foot Care

Foot Exams and Treatments (Medicare-covered)
20% Coinsurance
Routine Foot Care
Not Covered

Chiropractic Care

Medicare-covered chiropractic
$20 Copay
Routine chiropractic
$20 Copay

Mental Health Services

Outpatient individual therapy
$30 Copay
Outpatient group therapy
$30 Copay
Inpatient psychiatric hospital care
$185.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond

Rehabilitation Services

Physical therapy and speech and language therapy
Not Covered
Occupational therapy
Not Covered

Medical Equipment and Supplies

Diabetes supplies
20% Coinsurance
Durable medical equipment
20% Coinsurance
Prior Authorization Required
Prosthetics
20% Coinsurance

Diagnostics, Lab Services, and Imaging

Diagnostic radiology services
$50 Copay
Prior Authorization Required
Lab services
Not Covered
Outpatient x-rays
$10 Copay
Prior Authorization Required
Diagnostic tests and procedures
20% Coinsurance
Prior Authorization Required

Medicare Part B Drugs

Chemotherapy
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

Dental Services

Medicare Covered Preventive Dental
20% Coinsurance
Oral exam
$0
Dental x-rays
$0
Cleaning
$0
Periodontics
Not Covered
Endodontics
Not Covered
Restorative Services
Not Covered

Hearing Aids and Services

Fitting/evaluation
Covered
Limits may apply
Hearing aids
Not Covered
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
$ to $30 Copay
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None
If you qualify for Medicare Advantage but don't know where to begin, we have licensed insurance agents[1] at 1-855-728-0510 (TTY 711) who can answer your questions (Mon-Fri 5am-6pm, Sat 6am-5pm PT) and help you get enrolled. There's no obligation.

Prescription Drug Costs & Benefits

Great Plain Medicare Advantage Gold includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.

As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.

Prescription Drug Premium with Extra Help

Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.

Low Income Premium Subsidy: ${part_d_lips_amount}
Low Income Premium Subsidy CMS Pays: $20.30
Low Income Subsidy Premium: $0.00

If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.

Prescription Drug Deductible

The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Great Plains Medicare Advantage begins paying its share.

Prescription Drug Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Great Plain Medicare Advantage Gold has out-of-pocket costs you must pay when you pick up your prescriptions.

Drug Tier Retail Mail Order
Preferred Generic$4.00N/A
Generic$10.00N/A
Preferred Brand$45.00N/A
Non-Preferred Drug$95.00N/A
Specialty Tier33.00%N/A
Select Care Drugs$0.00N/A
*The Part D deductible does not apply.

How to Qualify to Enroll in
Great Plain Medicare Advantage Gold

To be eligible to enroll in Great Plain Medicare Advantage Gold, you must meet three requirements:

  1. You are eligible for Medicare;
  2. You live in Turner County (the plan’s service area); and
  3. You require the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.

If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).

Before joining Great Plain Medicare Advantage Gold, consider these questions:

  • Does the plan's provider network include my nursing home or home care provider?
  • What costs should I expect with my coverage (premiums, deductibles, copayments)?
  • Is there an annual limit on my out-of-pocket costs?
  • Will I be able to use my doctors? Are they in the plan's network?
  • Are the plan's in-network providers and facilities in convenient locations?
  • Does the plan provide coverage for services I receive from out-of-network providers?
  • Do I need a referral to see a specialist?
  • Are my medications on the Part D plan's formulary?
  • What special accommodations does the plan make for persons with disabilities?
  • What special language and cultural accommodations does the plan make?