If you live in Iowa, you may be eligible for Medicare. This federal program provides health insurance for Iowans who are 65 or older, as well as some younger people with disabilities.
If you’re new to Medicare, it’s not always easy to figure out your coverage options. This article offers an introduction to Medicare Iowa, including Medicare Advantage options and how to choose a plan that’s right for you.
There are two Medicare coverage options in Iowa. You can choose either original Medicare or Medicare Advantage. Read on to learn more about these options.
Original Medicare is also called traditional Medicare. It’s offered through the federal government, and it includes:
- Part A (Hospital Insurance). This part includes coverage for various hospital-related services, including inpatient hospital stays and skilled nursing facility care.
- Part B (Medical Insurance). This part includes coverage for many medically necessary and preventive services, including doctor services, physical exams, and flu shots.
Original Medicare doesn’t cover everything, but insurance companies offer plans that can help fill the gaps. If you need drug coverage, you can sign up for a Medicare Part D drug plan. If you need help paying for Medicare copayments, coinsurance, and deductibles, you can sign up for Medicare supplement insurance.
In Iowa, your other option is a Medicare Advantage plan. These plans are offered by private companies and are regulated by the government. They cover all the same hospital and medical services as original Medicare, but they often include extra benefits, such as:
Medicare Advantage and Medicare Part D prescription drug plans are subject to change every year. Updated plan information for 2021 should become available on October 1, in advance of Medicare’s Annual Election Period beginning October 15. Healthline.com will provide updated 2021 plan information once it is announced by the Centers for Medicare & Medicaid Services (CMS).
Iowans can shop for Medicare Advantage plans at Medicare.gov. As of 2020, the following carriers sell Medicare Advantage plans in Iowa:
- Coventry Health and Life Insurance Company
- Sierra Health and Life Insurance Company Inc.
- UnitedHealthcare of the Midwest Inc.
- CHA HMO Inc.
- Humana Insurance Company
- Medical Associates Health Plan Inc.
- HealthPartners UnityPoint Health Inc.
- Aetna Life Insurance Company
- Health Alliance – Midwest Inc.
- Harken Health Insurance Company
- PACE Iowa
- Union Pacific Railroad Employees Health Systems
- Quartz Health Plan Corporation
- Siouxland PACE Inc.
If you’re younger than 65, you’re eligible for Medicare Iowa if:
- You’ve been diagnosed with end stage renal disease (ESRD);
- You’ve been diagnosed with amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s disease;
- Or, you’ve been getting Social Security disability checks for at least two years.
For Iowans who are turning 65, meeting one of the following criteria makes you eligible for Medicare:
- You’re either a U.S. citizen or a permanent resident who’s been in the U.S. for at least five years.
- You currently receive Social Security retirement benefits or qualify for these benefits.
There are additional eligibility rules for Medicare Advantage plans in Iowa. To be eligible, you must live in the plan’s service area and have Medicare parts A and B.
If you’re eligible for Medicare, you can sign up at certain times during the year. These times include:
- Initial enrollment period. If you’re first eligible when you turn 65, you can sign up during this 7-month period. It starts 3 months before the month you turn 65 and ends 3 months after the month of your 65th birthday.
- Medicare open enrollment period. The annual open enrollment period happens between October 15 and December 7. At this time, you can join a Medicare Advantage plan or switch to a new plan.
- Medicare Advantage open enrollment period. If you’re already in a Medicare Advantage plan, you can switch to another one between January 1 and March 31 every year.
Certain life events, such as losing a job that provides you with health coverage, will trigger a special enrollment period. This gives you an opportunity to sign up for Medicare outside of the standard enrollment periods.
In some cases, you may be signed up for Medicare automatically. If you’re eligible because of a disability, you’ll get Medicare after you’ve received 24 months of Social Security disability benefits. You’ll also be signed up automatically when you turn 65 if you’re already getting Social Security retirement benefits.
When you’re shopping for Medicare Advantage plans, narrowing down your options can be overwhelming. To make the process easier, keep these things in mind as you shop around.
- Your budget. Before choosing a plan, decide how much you can afford to spend. Consider not only monthly premiums, but other coverage costs, such as coinsurance, copayments, and deductibles.
- Your doctors. When you join a Medicare Advantage plan, you typically get care from doctors in the plan’s network. If you want to keep seeing your current doctors, make sure they’re in the network.
- Your coverage needs. Medicare Advantage plans may cover services that original Medicare doesn’t, and these extra benefits vary from plan to plan. If you need specific benefits, such as dental care or vision care, make sure your plan offers them.
- Your health needs. If you have a chronic health condition, such as cancer or an autoimmune disease, you may want to join a Special Needs Plan. These plans tailor their services and provider networks to better suit the needs of people with specific conditions.
There are many helpful resources that can help you understand Medicare Iowa, including:
- Senior Health Insurance Information Program (SHIIP) 800-351-4664
- The Social Security Administration 800-772-1213
When it’s time to enroll in Medicare, you can:
- Sign up for Medicare parts A and B. To get Medicare, contact the Social Security Administration. There’s an online application, but if you prefer, you can visit your local Social Security office or call 800-772-1213.
- Shop for Medicare plans at Medicare.gov. The online Medicare plan finder tool makes it easy to shop for Medicare plans in Iowa. After entering your ZIP code, you’ll see a detailed list of plans you can choose from.
- Talk to a Medicare counselor. If you need help comparing Medicare plans in your area, contact the Iowa SHIIP. A SHIIP volunteer can help you understand your Medicare options and make more informed coverage decisions.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.