Medicare Advantage Plans in Iowa

Fact Checked
Published: June 18, 2021

Original Medicare provides health coverage for millions of Americans, ensuring that older adults and younger people receiving disability benefits have access to basic medical care. If you're looking for broader coverage than what Original Medicare provides, Medicare Advantage may be a good option. Medicare Advantage Plans usually include prescription coverage and may even provide coverage for services that aren't available under Original Medicare, giving you more flexibility in choosing services and providers.

  • In 2019, there were 42 Medicare Advantage Plans available in Iowa.
  • 19% of the total Medicare population in Iowa was enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,807 per beneficiary in Iowa, which is 13% lower than the national average.
  • Available Medicare Advantage Plans range from three to 21 across Iowa’s 99 counties.

Medicare Advantage Plans are available in all states except Alaska. If you decide to enroll, you’ll have the opportunity to compare plans and choose one based on its expected out-of-pocket costs and covered services. When you’re ready to purchase a plan, select one that makes sense based on your monthly income and how often you need medical care.

Medicare Advantage Plans in Iowa

Types of Medicare Advantage Plans

In Iowa, you may be able to choose an HMO plan, a PPO plan, a private fee-for-service plan, or a special needs plan. Each plan type has its own costs and restrictions. You may be familiar with some of the plans in Iowa’s Medicare Advantage program if you’ve ever had health coverage through an employer.

Health Maintenance Organizations (HMO)

HMO plans are usually less expensive than other types of health insurance. One reason for the lower cost is that each HMO has its own network of providers who agree to accept a certain level of payment for each service. The downside is that you must choose a primary care provider. What this means is that you can’t see a specialist without asking your PCP to give you a referral.

Preferred Provider Organizations (PPO)

PPO plans give you the freedom to see any provider, whether a provider is in your network or not. The difference is that you usually pay more if you decide to go to an out-of-network provider. Another advantage of choosing a PPO plan is that you can see a specialist without getting a referral from a PCP. Because PPO plans give you more freedom, they tend to cost more than HMO plans.

Private Fee-for-Service Plans (PFFS)

Some private fee-for-service plans have their own provider networks, while others are more flexible. Because PFFS plans don’t have the same reimbursement rates as Original Medicare, providers aren’t obligated to treat plan members. This means you may need to find a new doctor if you sign up for a PFFS plan. One advantage of enrolling in a PFFS plan is that you don’t need referrals for specialist care.

Special Needs Plans (SNP)

If you have a severe chronic health condition, you may be eligible for a special needs plan. This type of plan is designed for members who share a chronic illness or specific health characteristic. As a result, an SNP provides extensive coverage for the doctors, medications, and procedures you’re most likely to need. For example, some states have SNPs for people with chronic lung disorders, including asthma, emphysema, and pulmonary hypertension.

Enrollment and eligibility for Medicare Advantage Plans in Iowa

Medicare Advantage Eligibility

Iowa Medicare Advantage Plans are available to adults who qualify for Original Medicare. You may be eligible if you’re at least 65 years old, you have kidney failure (end-stage renal disease), or you’re under the age of 65 and receiving Social Security Disability Insurance payments.

If you want to enroll in Medicare Advantage, you can’t be enrolled in Medicare Supplement Insurance (Medigap).

Enrolling in Medicare Advantage

When you’re ready to sign up for Medicare Advantage, you can enroll in the plan of your choosing during one of these three periods:

  • Initial enrollment period. This period lasts for seven months, starting three months before you turn 65 and ending three months after your birthday month. During this period, you can sign up for Medicare Advantage or enroll in a supplementary drug plan (Medicare Part D).
  • Medicare open enrollment period. The annual open enrollment period runs from October 15th to December 7th. At this time, you can enroll in Medicare Advantage or switch plans.
  • Medicare Advantage open enrollment period. MA open enrollment runs from January 1st to March 31st. You can use this enrollment period to switch plans or go back to Original Medicare.

If you don’t enroll during the IEP, open enrollment, or Medicare Advantage open enrollment, you may not be able to sign up until the next year unless you qualify for a special enrollment period. You may be eligible for an SEP in certain circumstances, such as moving out of your current plan’s service area, losing your employer-sponsored health coverage, or losing your eligibility for an SNP.

Prescription drug coverage

Many Medicare Advantage Plans cover prescription drugs. If you have one of these plans, you can’t enroll in Medicare Part D, or else you’ll be taken off Medicare Advantage and signed up for Original Medicare. If you enroll in a PFFS plan that doesn’t cover prescriptions, then you can sign up for Medicare Part D drug coverage. Medicare Part D is a supplementary plan with its own premium, deductible, and copays. Depending on your health needs, you may want to choose a plan with a low premium and a high deductible or a more expensive plan that has a lower deductible.

Medicare Advantage Resources in Iowa

When it’s time to enroll in Medicare, you have two main options: enroll in an all-in-one Medicare Advantage Plan or sign up for Original Medicare and purchase Medicare Part D and/or Medigap coverage as needed. If you’re not sure which option is right for you, you can get assistance from one of the following organizations. Iowa has agencies dedicated to fighting Medicare fraud, educating consumers on their Medicare options, and helping Iowans resolve problems with their insurance companies.

Iowa Department on Aging

The Iowa Department on Aging serves as a link between older Iowans and the state’s six Area Agencies on Aging. Staff members at each regional AAA office provide information and assistance to older adults and their loved ones, ensuring that all Iowans have the opportunity to stay engaged as they get older. If you have questions about maximizing your Medicare benefits or need help understanding your Medicare Advantage options, contact IDA for a referral to the AAA office closest to you.

Contact Information: Website | 866-468-7887

Iowa State Health Insurance Assistance Program

Iowa’s State Health Insurance Assistance Program aims to educate and inform Iowa residents on their Medicare options. SHIP also operates the Iowa Senior Medicare Patrol program, which helps Medicare enrollees prevent and detect fraud. SHIP publishes a variety of information on Medicare topics, including Medicare Supplement Insurance, Medicare fraud, and the basics of Medicare Part A and B. If you have questions about Medicare or need help paying your out-of-pocket expenses, contact SHIP to speak with a counselor.

Contact Information: Website | 800-351-4664

Iowa State Insurance Division

In addition to overseeing SHIP and the Senior Medicare Patrol program, the Iowa State Insurance Division regulates health insurance companies and publishes information to help consumers understand their coverage and expected costs. The agency also accepts complaints related to the practices of insurance companies operating within Iowa’s borders. If your insurance company isn’t following the terms of your Medicare Advantage Plan, or you have a complaint about how the company handled one of your claims, contact ISID.

Contact Information: Website | 515-654-6600

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