Iowa Medicare Supplement Plans (Medigap)
Iowa Medicare Supplement plans were created to work with Medicare to supplement your Original Medicare coverage.
These benefits were created to provide coverage for what’s not covered by Original Medicare. This includes out of pocket expenses such as deductibles, copayments and coinsurance.
Medigap insurance policies are the same as Medicare Supplement policies. These plans are sold by private insurance companies. Iowa Medicare Options are separated into parts and plans.
Traditional Medicare covers Part A (Hospitalization) and Part B (Medical expenses). There is a 20% amount of your healthcare expenses that you can be responsible for. Having more coverage than Original Medicare can protect you from unexpected healthcare costs.
Medicare supplement or Medigap plans can cover the 20% Original Medicare does not cover. These plans will allow you to see any doctor who accepts Medicare assignment.
Medigap policies do not include prescription drugs, you will need to purchase a Part D, Prescription drug plan. These plans have a formulary (list of covered drugs), you will want to check with the plan to be sure all your medications are covered.
Part C is also known as a Medicare Advantage plan, these plans are typically low-cost plans because they receive a portion of your Part B premium to take responsibility of your Health Coverage.
Medicare will not be responsible for your healthcare claims if you are enrolled in a Medicare Advantage plan. Part C replaces Part A and Part B, and there are limitations. A Medicare Supplement with a Part D plan will get you the most comprehensive healthcare coverage.
What does Medicare Pay for in Iowa
Medicare does cover a variety of services, they do not cover them fully. The Medicare beneficiary is responsible for 20% of the healthcare expenses.
The beneficiary may be responsible for additional out of pocket costs. That’s why a Medigap plan is needed, to help cover the “gap” Medicare doesn’t.
Part A, hospital insurance, will cover things like hospital care, skilled nursing facility care, and hospice. It will cover nursing home care if custodial care isn’t the only care you need.
Part B, medical insurance will cover medically necessary and preventive services. You will pay a deductible and coinsurance for your Part A and B services.
If you choose to buy a Medicare Supplement insurance policy, your policy may pay some of these costs depending on what letter plan you choose to enroll in.
How to Qualify for Iowa Medicare Supplement Plans
To enroll in a Medigap policy you must be at least 65 years old and enrolled in Medicare Part B. You need to enroll in your Medicare Part B as soon as you are eligible to avoid the Part B Late Enrollment Penalty. Iowa Medicare Supplement plans are only available to residents in Iowa.
Medicare Eligibility in Iowa for the Under 65 and Disabled
Beneficiaries automatically get Part A and Part B after receiving disability benefits from Social Security or certain disability benefits from the Railroad Retirement Benefits for 24 months.
Some carriers offer plans to those under 65 on disability in some states, but not all. Federal law does not require insurance providers to offer Medicare Supplements for people who are disabled and under age 65. However, some state laws do.
If you are enrolled in Medicare under 65 due to a disability and/or end stage renal disease, your eligibility for a Medigap policy will depend on the state you reside. Contact us for more information on plans available in Iowa for those on disability, under 65.
How to Sign Up for Iowa Medicare Supplement Plans
Your Open Enrollment Period (OEP) begins the 1st day of the month you’re at least 65 years old and your Medicare Part B has become effective.
For example, if your birthday was May 31st and your Medicare Part B effective date was July 4th, then your OEP begins August 1st. Your OEP is in effect for 6 months and during this time you are granted Guaranteed Issue (GI).
Having the opportunity to use your Guaranteed Issue right is one opportunity you should not pass up. This means the Insurance company can’t refuse Medigap coverage. They must cover all your pre-existing health conditions. They can’t charge you more for a Medigap policy because of past or present health problems.
You can qualify for a GI in Iowa if your employer sponsored plan benefits are reduced. However, there is no defined threshold. You can also qualify for GI if you recently turned 65.
Pre-existing Condition Waiting Period
If you do not have health insurance for 63 days prior to signing up for a Medigap plan, the supplemental policies may require that you wait six months after your Medigap policy date before they will cover your pre-existing conditions.
Remember, your Original Medicare must pay its portion of you pre-existing condition medical costs while you are waiting for the Medigap policy to pay its portion.
To avoid this waiting period, you will need to offer proof of “creditable coverage”. Creditable coverage is any other health insurance policy you had before applying for your Medigap coverage.
If you can show you had at least six months of continuous coverage, your Medigap insurance company will not enforce the waiting period before.
You cannot have a lapse in the coverage for more than 63 days. You must verify that your prior insurance coverage is considered “creditable coverage.” Furthermore, make sure to enroll in a Medicare supplement plan as soon as you’re eligible for one.
Never cancel coverage until you have confirmed that your new policy has been approved and issued.
Once your Open Enrollment is Over
Once your Medigap Open Enrollment Period passes, you may not be able to enroll in a Medicare Supplement plan as easily if you’re doing so for the first time.
If you’re already enrolled in a Medigap plan, you may not be able to switch plans with guaranteed issue (except in certain situations). Without guaranteed-issue rights, you may be subject to medical underwriting and charged higher premiums based on your health status.
Insurance companies can also deny you coverage if you have health problems. It’s usually more difficult to find Medicare Supplement coverage after your Medigap Open Enrollment Period has passed if you have disabilities or pre-existing conditions. Even if you can find a Medigap plan that will accept you, your premium costs may be higher.
Iowa Medicare Supplement Plans Premiums
The cost of a Medicare Supplement policy is determined by the insurance company and not the state. The price is determined based off many different factors including; age, sex, and location. A plan in Des Moines will not be the same cost as a plan in Cedar Rapids.
Each carrier uses 1 of these 3 rating methods
- Community Rated
- Issue Age Rated
- Attained Age Rated
Top Medicare Supplement Plans in Iowa
It does not matter the company you go with for your Medigap coverage. The only difference between the plans is the cost the carrier chooses to charge. Plan F is always a Plan F, no matter the company, it is the same coverage.
The top letter plans are F, HDF, G and N.
- Most Popular choice of all Medicare recipients
- Minimal out of pocket costs
- After Medicare pays their portion of the claim, this plan pays most of the remaining hospital and doctors cost.
- Plan F will cover 100% of Part A deductible
- Medicare Plan F will cover your coinsurance costs of days 61-90
- Statistics show 20% of seniors end up back in the hospital shortly after going home.
- If you are in the hospital longer than 90 days, Medicare Plan F will extend your hospital coverage for an additional 365 days.
- Traditional Medicare does not cover any foreign travel benefits. This supplemental health insurance will cover medical emergencies while traveling to a different country. This is as long as your medical care started within the first 60 days of leaving the United States.
High Deductible Plan F
- Same coverage as Plan F, just with a deductible of $2,240 for 2018
- You are responsible for any medical expenses up to your deductible
- The premium is significantly lower than Plan F
- Medicare Plan G and F are the only plans toexcess charges from Medicare Part B
- The only difference in Plan F and G, Plan G does not cover the Part B deductible
- The Part B deductible is $183 per year
- Plan G has shown to have a lower rate increase trend from year to year
- This means you can save money in the short and long term
- While Plan N may not offer the fullest coverage of all the plans available, Plan N can cost less than other plans.
- Includes Medicare Part A hospitalization deductible
- Does NOT cover the Medicare part B deductible
- Requires the patient to pay a small deductible for physician visits and emergency room visits
- Does NOT cover Medicare Part B excess charges
- Plan N does cover Home Healthcare, but coverage does not start until the Medicare Part B deductible is met
- Covers 80% of any emergency care needed within the first 60 days of foreign travel.
- Co-payments include up to $20 for some office visits as well as up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission
- Plan N will pay 100% of your Part B coinsurance, minus the above co-payments
Iowa Medicare Advantage Plans
Medicare Part C is an option that will require you to give up Original Medicare Parts A and B as your primary coverage.
The insurance carrier you choose will be your primary coverage; you no longer have Medicare Part A & B because Part C will take the place of these. Instead of Medicare handling your insurance claim, the private insurance company will take on the risk.
You are required to adhere to the provider network chosen by the carrier you select. However, this network can change anytime throughout the year. These plans are attractive, most of them having a much lower premium than Medigap plans, or no premium.
Most times the Medicare Advantage will already include a Prescription Drug Plan (PDP). Even though these policies can seem far less of a hassle up front, the entire picture needs to be looked at.
When you start needing the coverage to work on your side, there will be an out of pocket cost. These costs will eliminate any saving in premium you may have acquired from not having a Medigap policy.
Iowa Medicare Prescription Drug Plans (PDP)
Part D plans cover prescription drugs. Prescriptions are not covered under Original Medicare Parts A & B, purchasing a PDP will allow you to avoid paying the full cost of expensive medicine.
Part D does not cover over the counter prescriptions. It also doesn’t usually cover drugs for things like: cosmetic issues, weight loss or sexual dysfunction. Each PDP has a formulary that is broken down into tiers of drugs, based on their cost.
- Plans are broken down in the coverage phases. The first phase is the deductible (if there is a deductible, some Part D plans don’t have a deductible in some areas). In the Deductible phase the enrolled person pays prior to coverage kicking in.
- In the Initial Coverage phase your plan pays 75% of your prescription drug costs. You pay 25% up to the plan limit.
- The Coverage Gap also known as the donut hole. It will pay 49% for generic drugs and 10% for brand name drugs. For brand name drugs, the manufacturer discounts the costs by 50%. This discount is counted as an enrollee out of pocket cost expenditure. The enrollee pays 51% of the cost for generic drugs and 40% of the cost of brand name drugs.
- The last phase is the Catastrophic Coverage, once you’ve reached the annual out of pocket maximum the plan pays for 95% of your drug costs
Part D Late Enrollment Penalty
If you do not enroll in a Part D plan you could encounter a Part D Late Enrollment Penalty. For each month without coverage, you will pay an additional premium of 1 percent of the current “national base beneficiary premium.”
This is NOT a one-time penalty. You will pay it every month for as long as you have Medicare prescription coverage. Since it is based on the year’s national beneficiary premium, it may go up and change each year. You can always check out the Part D Coverage Changes for 2018
How to Apply for Iowa Medicare Supplement Plans
Insurance agents have a fiduciary responsibility to make sure your health care coverage is right for you. Having an insurance agent can make getting answers and understanding your policy easier for you.
If you prefer you can compare rates online for Iowa Medicare Supplement plans, click here.
Medicare Savings Programs (MSP) are federally funded programs administered by each individual state. These programs are for limited income Medicare recipients to help pay some or all Medicare premiums, deductibles, copayments and coinsurance.
If you are on a fixed income, you may be able to qualify for the Medicare Savings Program and Extra HelpPairing a Medicare Supplement with your Medicare Savings program is a good way to protect yourself from high medical bills due to chronic condition or unexpected illness or accident.
Call the number above to speak to an Agent about your situation and budget. Let them help you find the right plan.
Iowa Medicare FAQ’s
- Does Iowa Medicare cover chemotherapy?
- If you have Medicare Parts A and B Medicare covers chemotherapy if you are a cancer patient who is a hospital inpatient or outpatient, or you are a patient in a doctor’s office or freestanding clinic. You will pay the 20% of the Medicare-approved amount if you get your treatment in a doctor’s office, the Part B deductible applies. You pay a copayment if you are a hospital outpatient. If you have a Medicare Supplement you will have the most comprehensive coverage available to you.
- Who to call to sign up for Medicare in Iowa?
- Contact Social Security either online, at your local office or by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). If you worked for the railroad, call the RRB at 1-877-772-5772. Medicare.gov has information on how to get Parts A and B. Once you enroll in Part B, give us a call to enroll in one of the 10 Iowa Medicare Supplement Plans.
- Who in Des Moines IA takes Medicare for dentures?
- You can speak with a licensed insurance agent in the state of Iowa about plans available to you, call the number above.!