Medicare Advantage Plans in Iowa

Medicare Advantage plans in Iowa are an alternative way of getting the benefits of Original Medicare (Part A and Part B). Many Medicare Advantage plans have additional coverage options that Original Medicare doesn’t include.

Medicare Advantage is also known as Part C. Read on to learn all about Medicare Advantage plans in Iowa, and to find out how you can get coverage.

Medicare Advantage (Part C) plans are sold by private insurers who have a contract with Medicare. In many instances, Part D prescription drug coverage is also included.

Medicare Advantage plans by law must provide at least as much coverage as Parts A and B of Original Medicare. Many plans also provide coverage for healthcare services Original Medicare doesn’t have. These include:

• Vision care
• Hearing aids
• Dental services
• Wellness programs such as SilverSneakers memberships at gyms

Some Medicare Advantage plans require you to choose your doctors and providers in-network. Others have more flexibility about the doctors and providers you may see. There are also differing costs per plan.

In Iowa in 2023, Medicare Advantage (Part C) plans were available to 97 percent of residents who were eligible for Medicare. There are four types of plans:

• HMO (Health Maintenance Organization) – HMOs require you to use in-network doctors and hospitals. They also require referrals for specialist appointments.
• PPO (Preferred Provider Organization) – You can see in-network or out-of-network providers, although your costs for each will vary.
• PPFS (Private Fee-For-Service) – A flexible plan that lets you keep or choose your doctors for a set fee.
• SNP (Special Needs Plan) – Eligibility is restricted to people with certain chronic conditions.

Not every plan is available in every area. The plans you can purchase may vary, based upon your eligibility, as well as your county and zip code.

You must sign up for Original Medicare before you can buy a Medicare Advantage plan. Original Medicare has two parts: Part A and Part B. Part A is premium-free for most people. Part B has a monthly premium you will be required to pay, even after you have solidified your Part C coverage. For most people, the Part B monthly premium cost $164.90 in 2023. Your cost may be higher if the modified adjusted gross income on the tax return you filed two years ago is over a certain amount.

In Iowa, Medicare Advantage plans vary in terms of cost as well as coverage. There are many plans that are premium free. Premium-free plans don’t require you to pay an additional monthly fee over your Part B premium for healthcare.

When choosing a plan, check the costs listed for:

• Monthly premiums.
• Copays for your primary care physician appointments and specialist appointments.
• Coinsurance costs for hospitalizations and services such as radiological tests.
• Deductibles for healthcare and for prescription drugs, if your plan has a Part D benefit.
• The maximum dollar amount you will pay annually for in-network and out-of-network health services.

To be eligible for Medicare Advantage in Iowa, you must be eligible for, and have, Original Medicare. You must also live in the service area of the plan you choose.

People who are 65 and older can buy Medicare Advantage in Iowa from private companies. So can people who have specific disabilities, no matter their age.

If you have a disability that qualifies you for Medicare, you will automatically get Part A and Part B after you’ve received 24 months of disability benefits from either Social Security.

If you have ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease) you will automatically get Parts A and B the month you start receiving disability benefits.

At one time, people with end-stage renal disease (ESRD) could not buy Medicare Advantage plans in Iowa, but that has changed. If you’ve been diagnosed with ESRD, you may be able to get Part C in your county of residence.

In Iowa, there are certain times of year when you can enroll in a Medicare Advantage plan:

Initial Enrollment Period – If you are newly eligible for Medicare Advantage because you are turning 65, your initial enrollment will start three months before your 65th birthday and end three months after your 65th birthday, for a total of seven months.

Open Enrollment Period – Also known as the Annual Enrollment Period, you can join, switch or drop a Medicare Advantage plan from October 15 to December 7 annually.

Medicare Advantage Open Enrollment Period – You don’t have to keep a Medicare Advantage plan you don’t like. In some instances, you may find that your medical needs have changed, and you need a different type of plan. If you already have a Medicare Advantage plan but it no longer works for you, you can change to a new plan anytime from January 1 to March 31 each year.

Many Medicare Advantage plans in Iowa fold in prescription drug coverage. If you have a Part C plan that includes prescriptions, you don’t need to purchase an additional Part D plan.

Medicare Advantage plans each have a formulary. This is a list of the brand name and generic drugs that the plan will pay for. If you currently take medications, you can check to see if they’re included in a plan’s formulary before you buy it. If you love a plan but don’t see your medication listed, talk to your doctor. They may be able to recommend an alternative medication for you.

Formularies typically have between two and five coverage tiers. Each tier includes drugs that have the same or similar copays. Generics may be in one tier, and prescription drugs may be in another. Specialty drugs may be in a third tier and often have the highest copays.