Great Plains Medicare Advantage Gold (HMO I-SNP) Medicare Special Need Plan H7511-004 • 2027
- Monthly Premium
- $119.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3750.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $300.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 0 beneficiaries
Introduction
CMS Plan ID H7511-004 identifies Great Plains Medicare Advantage Gold, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Great Plains Medicare Advantage. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $119.00 monthly premium, $0.00 medical deductible, and $3750.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $300.00.
Enrollment across the plan's service areas totals 0 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
- 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.
Plan Benefits
Great Plains Medicare Advantage Gold 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 H7511-004.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | Coming soon |
| Specialist | In-network: $30 copay | Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Coming soon |
| Telehealth benefit | In-network: $0-$200 copay | Coming soon |
| Routine chiropractic | In-network: $30 copay | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | Not covered | Coming soon |
| Counseling services | Not covered | Coming soon |
| Over-the-counter drug benefits | Not covered | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$50 copay | Coming soon |
| Lab services | In-network: 20% coinsurance | Coming soon |
| Outpatient x-rays | In-network: $10 copay | Coming soon |
| Diagnostic tests and procedures | In-network: $0 copay | Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $90 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $0-$30 copay | Coming soon |
| Inpatient hospital care | Tier 1 $300 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Coming soon |
| Skilled Nursing Facility | Tier 1 $0 per day for days 1-20 $100 per day for days 21-100 |
Coming soon |
| Ground ambulance | In-network: $150 copay | Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $30 copay | Coming soon |
| Outpatient group therapy | In-network: $30 copay | Coming soon |
| Inpatient psychiatric hospital care | Tier 1 $300 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 copay | Coming soon |
| Occupational therapy | In-network: $0 copay | Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 20% coinsurance | Coming soon |
| Durable medical equipment | In-network: 20% coinsurance | Coming soon |
| Prosthetics | In-network: 20% coinsurance | Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | Coming soon |
| Dental x-rays | In-network: $0 copay | Coming soon |
| Cleaning | In-network: $0 copay | Coming soon |
| Periodontics | In-network: $0 copay | Coming soon |
| Endodontics | In-network: $0 copay | Coming soon |
| Restorative services | In-network: $0 copay | Coming soon |
| Implant services | In-network: $0 copay | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | In-network: $0 copay | Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | Coming soon |
| Contact lenses | In-network: $0 copay | Coming soon |
| Eyeglass frames only | In-network: $0 copay | Coming soon |
| Eyeglass lenses only | In-network: $0 copay | Coming soon |
| Eyeglasses (frames & lenses) | Not covered | Coming soon |
| Upgrades | In-network: $0 copay | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | Coming soon |
| Fitting/evaluation | In-network: $0 copay | Coming soon |
| Prescription hearing aids | In-network: $0 copay | Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | Not covered | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
Certain preventive services are covered 100% by Great Plains Medicare Advantage Gold as a Part B benefit.
Prescription Drug Coverage
Great Plains Medicare Advantage Gold 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: | $39.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $39.00 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $24.60 |
| Low-Income Subsidy Premium: | $14.40 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $300.00 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 Gold may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Not available |
| Generic | $8.00 copay | Not available |
| Preferred Brand | 25% coinsurance | Not available |
| Non-Preferred Drug | 30% coinsurance | Not available |
| Specialty Tier | 30% coinsurance | Not available |
| Select Care Drugs | $0.00 copay | Not available |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H7511)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| 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.
Plan Availability
Great Plains Medicare Advantage Gold (H7511-004-0) is available in the following locations (click to open):
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 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | April 28, 2026 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
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.