Guide to Medicare in Iowa

Your journey to Medicare in Iowa can go in several different directions. You can stick with Original Medicare, or choose to enroll in a Medicare Advantage, Medicare Supplement, or Part D plan for additional health or financial benefits. The first step is determining what you need most. What health benefits are most important to you, and what can you afford?

Click below to learn more about Iowa Medicare:

• Medicare in Iowa Eligibility
• What Does Medicare in Iowa Cover?
• Types of Medicare Plans in Iowa
• Medicare Advantage in Iowa
• Medicare Supplement Plans in Iowa
• Part D Plans in Iowa
• Cost of Medicare in Iowa
• Can I Have Medicaid and Medicare in Iowa?
• Additional Programs in Iowa
• How to Apply for Medicare in Iowa

Medicare in Iowa Eligibility

Most people become eligible for Medicare by turning 65. However, there are other ways to qualify regardless of your age. If you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you can qualify for Medicare before your 65th birthday. If you have been receiving SSDI (Social Security Disability Insurance), you will be automatically enrolled in Medicare during your 25th-month of SSDI benefits. To qualify for Medicare Advantage, Medicare Supplements, or Part D, you must be enrolled in Original Medicare first.

What Does Iowa Medicare Cover?

Original Medicare consists of Part A (hospital coverage) and Part B (medical coverage). Part A covers hospital stays, nursing homes, hospice, and home health services, whereas Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and x-rays.

Types of Medicare Plans in Iowa

Beyond parts A and B, Medicare in Iowa consists of Medicare Advantage, Medicare Supplements, and Part D. Each option provides some type of coverage beyond Original Medicare, like financial benefits, health benefits, or drug coverage. It’s important to enroll in some type of prescription drug coverage to avoid incurring a late-enrollment penalty down the road.

Medicare Advantage in Iowa

There are more than 115,000 beneficiaries enrolled in a Medicare Advantage (MA) plan across the state of Iowa. These plans offer additional coverage beyond Original Medicare. Some of the most popular benefits include hearing, dental, vision, over-the-counter drugs, non-emergency transportation, and group fitness classes, like Silver & Fit. These plans are sold through private insurance companies, and our licensed agents can show you plans that are available in your area and help you enroll. Click here or call 844-431-1832 to speak with a licensed agent.

Medicare Supplement Plans in Iowa

Iowa Medicare Supplement plans are organized by letter (A, B, C, D, F, G, K, L, M, N), and each letter represents a different level of coverage. Medicare Supplements work alongside Original Medicare and provide financial benefits. Depending on which plan you choose, you can get help paying for your Part A coinsurance and hospital costs, Part B coinsurance and copayments, blood work copays (up to three pints), hospice coinsurance and copayments, skilled nursing facility coinsurance, Part A deductible, Part B deductible, Part B excess charges, and foreign emergency travel.

Iowa Medicare Supplements are generally the same regardless of which carrier you enroll with, but sometimes they may add extra benefits, like SilverSneakers. Plan pricing will vary based on carrier, zip code, age, gender, and tobacco use. Even though plans may generally be the same, you don’t want to overpay if there’s a cheaper plan on the market. Our licensed agents can help you explore plans in your area and find the best plan for you. Click here or call 844-431-1832 to speak with a licensed agent.

Part D Plans in Iowa

Part D plans work alongside Original Medicare to provide prescription drug coverage. If you purchase a Part D plan, you will first have to pay your annual deductible ($415 in 2019). Some plans may reduce or waive your deductible up front. Once you meet the established deductible, your coverage begins, and you will be responsible for a copay per each prescription drug you purchase. You will continue to pay a copay until you reach the spending limit ($3,820 in 2019). After you reach the spending limit, you are considered to be in the “donut hole,” but don’t worry – the donut hole is going away in 2020! While you’re in the donut hole, you will be responsible for 37% of generic drug costs and 25% of brand-name drug costs until your annual spending reaches $5,100. After this point, you are considered to be in the catastrophic coverage phase, and you are only responsible for 5% of your total drug costs.

Cost of Iowa Medicare

The cost of Original Medicare in Iowa is the same as every other state. Your Part A premium is based on how many quarters you worked and paid Medicare taxes.

• 40 or more quarters = No Part D premium
• 30-39 quarters = $240/month
• Less than 30 quarters = $437/month

Your Part B premium is based on your income, but most beneficiaries will pay $135.50/month in 2019. Costs for Medicare Advantage, Medicare Supplements, and Part D plans will vary based on your location, carrier, and plan benefits. One of our licensed agents can show you plans in your area. Click here or call 844-431-1832 to speak with a licensed agent.

Can I Have Medicaid and Medicare in Iowa?

Medicare is designed for older adults over the age of 65 and people with certain disabilities. Medicaid is designed for low-income individuals and families regardless of age. Both programs provide health coverage and are regulated through the Centers for Medicare and Medicaid Services.

There are more than nine million people enrolled in both Medicare and Medicaid across the U.S. If you qualify for both programs, you may be eligible for a Dual Special Needs Plan (DSNP). DSNPs are a special type of Medicare Advantage plan that offers extra benefits at lower costs. They also provide a Special Enrollment Period (SEP). Most beneficiaries can only make changes to their coverage once a year, but SEPs allow you to get the coverage you need when you need it.

If you qualify for a DSNP, you may be eligible for other cost-saving programs. Medicare’s prescription drug program, Extra Help, can help you save more than $4,000/year on prescription drug costs. Other Medicare Saving Programs can help provide coverage for other Medicare-related costs like premiums, deductibles, copayments, and coinsurance

Additional Programs in Iowa

Several programs throughout Iowa are designed to help older adults, disabled individuals, and families maintain health and comfort. These programs include:

Supportive Services: Supportive services allow older adults and people with certain disabilities to maintain their independence through assistance with personal care, home care, and community services.

Health, Prevention, and Wellness: The Iowa Department on Aging helps maintain several prevention and wellness programs that provide access to services and activities that improve health, function, and quality of life.

Caregiver Support: Iowa’s Caregiver Support program helps provide information, assistance, counseling, education, and respite care services to families and caregivers.

Employment: The employment program is designed to help older adults throughout Iowa gain access to employment and assist with maintaining self-sufficiency.

Protective Services: There are several protective services throughout the state that help maintain the older adult’s rights. Programs include legal assistance, elder abuse prevention and awareness, and Office of Public Guardian.

How to Apply for Medicare in Iowa

You can sign up for Original Medicare through Social Security. You can visit www.SocialSecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday 7 AM to 7 PM, or apply in person at your local Social Security office.

Once you are enrolled in Original Medicare, you can schedule an appointment with one of our agents and discuss Medicare Advantage, Medicare Supplement, and Part D plans. Click here or call 844-431-1832 to speak with a licensed agent.