Great Plains Medicare Advantage (HMO I-SNP) H1787-001 • 2027 • Ransom County, ND
- Monthly Premium
- $5.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Ransom County, ND
- Local Enrollment
- 0 beneficiaries in Ransom County
Introduction
Great Plains Medicare Advantage is a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Great Plains Medicare Advantage. The plan uses a Health Maintenance Organization (HMO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $5.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H1787-001 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
You must live in Ransom County, North Dakota to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Ransom County. For assistance with this plan, new members can call (877)701-0784 (TTY 711).
Eligibility
Great Plains Medicare Advantage is a Hybrid Institutional (HI-SNP) plan for individuals that require nursing care.
- Special Needs Plan Type
- Institutional Special Needs Plan (I-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan accommodates individuals in a long-term care facility. It is also available to people who need the level of care given in a long-term care facility who can remain at home or live in an assisted living facility.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Ransom County
Compare this plan with the most-enrolled other HMO I-SNP plan available in Ransom County, North Dakota. Enrollment is based on CMS local enrollment data.
| Plan Detail | Great Plains Medicare Advantage | Great Plain Medicare Advantage Gold |
|---|---|---|
| CMS Plan ID | H1787-001-0 |
H1787-002-0 |
| Local Enrollment | 0 | 0 |
| Monthly Premium | $5.00 | $106.00 |
| Medical Deductible | Coming soon | Coming soon |
| Maximum Out-of-Pocket | $9,850.00 | $3,750.00 |
| Part B Giveback | Coming soon | Coming soon |
| Primary Care | Coming soon | Coming soon |
| Specialist | Coming soon | Coming soon |
| Part D Deductible | $700.00 | $300.00 |
| CMS Star Rating | Not yet rated | Not yet rated |
| Dental | Coming soon | Coming soon |
| Vision | Coming soon | Coming soon |
| Hearing | Coming soon | Coming soon |
Plan Benefits
Great Plains Medicare Advantage has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1787-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H1787-001-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: 20% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: 0%-20% coinsurance
- Routine chiropractic
- In-network: $0 copay
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 20% coinsurance
- Lab services
- In-network: 20% coinsurance
- Outpatient x-rays
- In-network: 20% coinsurance
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $90 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- 20% coinsurance
- Inpatient hospital care
- Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150 - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$217 per day for days 21-100 - Ground ambulance
- In-network: 20% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 20% coinsurance
- Outpatient group therapy
- In-network: 20% coinsurance
- Inpatient psychiatric hospital care
- Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 20% coinsurance
- Occupational therapy
- In-network: 20% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 20% coinsurance
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- Not covered
- Dental x-rays
- Not covered
- Cleaning
- Not covered
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Great Plains Medicare Advantage as a Part B benefit.
Prescription Drug Coverage
Great Plains Medicare Advantage includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $5.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $5.00 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $5.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Great Plains Medicare Advantage starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Great Plains Medicare Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | 25% coinsurance |
| Generic drugs | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1787)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Great Plains Medicare Advantage
- Website
- Great Plains Medicare Advantage Plan Page
- Providers
- Great Plains Medicare Advantage Providers Page
- Formulary
- Great Plains Medicare Advantage Formulary Page
- Pharmacy
- Great Plains Medicare Advantage Pharmacy Page
- New Member Health Plan Help
- (877)701-0784
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (877)701-0784
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Great Plains Medicare Advantage (official source) | http://www.greatplainsmedicareadvanta | October 4, 2026 |
| CMS.gov | Institutional Special Needs Plans (I-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.