Great Plains Medicare Advantage Gold (HMO I-SNP)
Available to residents of Pawnee County, NE for 2027. Contract H7511, plan 004, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $119.00 |
|---|---|
| — medical (Part C) part | $80.00 |
| — drug (Part D) part | $39.00 |
| In-network out-of-pocket maximum | $3,750.00 |
| Drug deductible | $300.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO I-SNP |
| Special needs plan | Institutional SNP |
| Contract / plan | H7511-004-0 |
| Offered by | Great Plains Medicare Advantage |
| Parent organization | Sanford Health |
| Formulary tiers | 6 |
| Member services | (877)701-0784TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- 4.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H7511 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $8.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 30% |
| Tier 5 · Specialty Tier | 30% |
| Tier 6 · Select Care Drugs | $0.00 |
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Managing Chronic (Long Term) Conditions | ||
| Special Needs Plan (SNP) Care Management · C07 | 5 out of 5 stars for Special Needs Plan (SNP) Care Management | 5 out of 5 stars for Special Needs Plan (SNP) Care Management |
| Care for Older Adults – Medication Review · C08 | 2 out of 5 stars for Care for Older Adults – Medication Review | 5 out of 5 stars for Care for Older Adults – Medication Review |
| Care for Older Adults - Functional Status Assessment · C09 | 2 out of 5 stars for Care for Older Adults - Functional Status Assessment | new measure |
| Transitions of Care · C19 | 1 out of 5 stars for Transitions of Care | not enough data |
| Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20 | 1 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | 1 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions |
| Health Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 4 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 4 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD2: Member Complaints and Changes in the Drug Plan’s Performance | ||
| Drug Plan Quality Improvement · D04 | 3 out of 5 stars for Drug Plan Quality Improvement | 3 out of 5 stars for Drug Plan Quality Improvement |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | 4 out of 5 stars for MPF Price Accuracy |
| Medication Adherence for Diabetes Medications · D08 | 5 out of 5 stars for Medication Adherence for Diabetes Medications | 5 out of 5 stars for Medication Adherence for Diabetes Medications |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 5 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | 4 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) |
| Medication Adherence for Cholesterol (Statins) · D10 | 5 out of 5 stars for Medication Adherence for Cholesterol (Statins) | 5 out of 5 stars for Medication Adherence for Cholesterol (Statins) |
| Statin Use in Persons with Diabetes (SUPD) · D11 | 4 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) | 4 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) |
| Concurrent Use of Opioids and Benzodiazepines (COB) · D12 | 4 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB) | new measure |
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13 | 4 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | new measure |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H7511 shares it.
Also available in 55 other NE counties
- Adams
- Antelope
- Boone
- Boyd
- Brown
- Buffalo
- Burt
- Butler
- Cass
- Cedar
- Clay
- Colfax
- Cuming
- Custer
- Dakota
- Dixon
- Dodge
- Douglas
- Fillmore
- Franklin
- Furnas
- Gage
- Gosper
- Hall
- Hamilton
- Harlan
- Holt
- Howard
- Jefferson
- Johnson
- Kearney
- Knox
- Lancaster
- Madison
- Merrick
- Nance
- Nemaha
- Nuckolls
- Otoe
- Phelps
- Pierce
- Platte
- Polk
- Rock
- Saline
- Sarpy
- Saunders
- Seward
- Sherman
- Stanton
- Valley
- Washington
- Wayne
- Webster
- York
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.