Medicare Plan Options
Original Medicare bundles Part A and B, creating reasonably comprehensive coverage. If you select Original Medicare, you have the opportunity to add Part D prescription drug coverage. For seniors in good health, Original Medicare makes good financial sense. When you need a little more coverage flexibility to help with acute or chronic issues, Iowa’s Medicare Advantage program may be a better solution. Some Part C plans include drug, dental, and vision expenses. Supplemental insurance may fill in coverage gaps with Original Medicare. In Iowa, health care is a mix and match solution.
As a federal program, Original Medicare is available to Iowans who meet the eligibility requirements, which means anyone 65 and over. This basic Medicare plan consists of two parts. Part A is coverage for hospital stays and associated charges, along with any covered long-term care such as skilled nursing, rehabilitation, or hospice. Part B covers standard and preventive care such as doctor’s visits, in-home health services, cancer screenings, and heart health checks. As a fee-for-service insurance option, you pay a premium to Medicare for the coverage and an out-of-pocket fee as you use your coverage.
Medicare Advantage Plans
Medicare Advantage Plans, known as Part C, pay for everything Medicare Parts A and B do, along with additional coverage. Some plans include vision or dental, while others might cover hearing aid supplies. Medicare Advantage Plans are sometimes tailored to specific illnesses, such as heart disease or diabetes. Part C may pay for services that don’t traditionally fall under health insurance, such as a gym membership or transportation to and from medical appointments. Since Medicare Advantage Plans are offered through private insurance companies, coverages may change each year.
Medicare Prescription Drug Coverage Plans
Prescription drugs are not automatically included in Original Medicare or Part C. If you need prescription coverage, you’ll need to either add Part D to your existing Original Medicare or choose an Advantage plan that includes a drug formulary. If you wait too long to add Part D to Original Medicare, there may be a penalty charge when you enroll. Medicare Advantage Private Fee-For-Service Plans are the only MA plans where you can add Part D. Each Part D plan has a list of covered drugs.
Medicare Supplement Insurance Plans
Medicare typically pays 80% of the negotiated rate for covered services, leaving you with a sometimes hefty copay. Medicare Supplement Insurance Plans, or Medigap, may cover that 20%, reducing your out-of-pocket costs at the time of service. Medigap plans are designed to fill in coverage gaps in Original Medicare and are not compatible with Advantage Plans. Some examples of coverage gaps might include the 20% coinsurance or any health services provided overseas.
Medicare in Iowa by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|477,859||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Iowa
Health insurance is a complex topic with many factors that can impact total costs, making it challenging for first-time enrollees. Iowans who seek assistance with the process have access to several statewide counseling programs that offer unbiased help from trained experts.
Senior Health Insurance Information Program
In Iowa, the Senior Health Insurance Information Program (SHIIP) is available statewide through a network of counseling programs provided by local agencies. Insurance counselors are trained to compare different Medicare coverage options and provide unbiased information to you. There is no cost for insurance counseling services, and counselors do not receive any compensation from the plans they suggest.
Contact Information: Website | 800-351-4664
Iowa Division of Insurance
The Iowa Division of Insurance administers all insurance companies in the state, ensuring every plan meets minimum coverage requirements. The agency has programs designed to help seniors find additional financial assistance for health care services, including information about Medicaid programs and discount programs for specific prescriptions. The IDI sponsors SHIIP Medicare counseling through its offices.
Contact Information: Website | 515-654-6600
Iowa Department on Aging
The Iowa Department on Aging operates a network of Area Agencies on Aging throughout the state. Each AAA location offers SHIIP counseling along with a variety of other senior-centered services. Caregivers can find a wealth of information and support resources available, and you may be able to schedule an in-person or telephone session to discuss various health insurance options with a SHIIP counselor or make an appointment with a social worker.
Contact Information: Website | 800-532-3213
Iowa Legal Aid
Iowa Legal Aid provides assistance tailored to meet the needs of residents who are 60+. These services include low- and no-cost legal advice and information about various public benefits programs, including what to expect from Medicare. If you have a dispute with Medicare or a health care provider, Legal Aid may be able to help. Guardianships, wills, trusts, financial planning, and long-term care are just some of the issues that Legal Aid regularly handles.
Contact Information: Website | 800-532-1275