As a Medicare beneficiary in Iowa, you may have the option of Medicare Advantage (Medicare Part C), an alternative way to receive your Medicare Part A and Part B coverage.  Medicare Advantage plans are offered by Medicare-approved private insurance companies. The availability of Medicare Advantage plans depends on the Iowa zip code in which you live.

How Medicare Advantage works in Iowa

Medicare Advantage plans in Iowa are required by the United States government to offer at least the level of coverage as Original Medicare, Part A (hospital insurance)  and Part B (medical insurance), with the exception of hospice care which remains covered by Part A. Medicare Advantage plans in Iowa may also offer extra benefits, like routine vision services and prescription drug coverage.

If you want to enroll in a Medicare Advantage plan in Iowa, you’ll need to be aware of the eligibility requirements and enrollment periods:

  1. You must have Medicare Part A and Part B;
  2. You must live in the Medicare Advantage plan’s service area; and
  3. In most cases, you cannot have end-stage renal disease (kidney failure), the treatment for which is covered through Original Medicare.

You may enroll in a Medicare Advantage plan during one of several periods.

You are first eligible to enroll during your Initial Coverage Election Period (ICEP). Your first The Initial Coverage Election Period is usually the same as the Initial Enrollment Period (the period of time during which you first become eligible for Medicare Part A and Part B).  The Initial Coverage Election Period is the seven-month period that starts three months before the month you turn 65. The ICEP then runs through your birth month and for the three months after.

If you delay enrollment in Medicare Part B, your ICEP is the three-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 until March 31), your Part B start date would be July 1, so your ICEP would be April 1 through June 30.Each year after your first year of Medicare coverage you can enroll in a Medicare Advantage plan, or change to a different Medicare Advantage plan, during the Annual Election Period, also called the Fall Open Enrollment season, which runs from October 15 to December 7 of each year. The new coverage goes into effect on January 1 of the following year.

In some cases, you may be able to enroll or switch Medicare Advantage plans during a Special Election Period.  A Special Election Period occurs when a change in your life or in your health plan coverage occurs and waiting for an established enrollment period, such as the Annual Election Period, could put you at risk of not having Medicare coverage when you are eligible to receive it. Some examples of these types of changes include, but are not limited to, your move to a new residence that is outside the service area of your Medicare Advantage plan, or moving into or out of a nursing home.

If you decide to disenroll from your Medicare Advantage plan and switch back to Original Medicare Part A and Part B, you can do this during the  Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 in Iowa and the rest of the United States. If you do that, you can also add a stand-alone Medicare Part D plan for prescription coverage during that time to go alongside your Original Medicare.

Types of Medicare Advantage plans in Iowa

If you’re interested in signing up with a Medicare Advantage plan , you may want to familiarize yourself with the various types of Medicare Advantage plans that may be available where you live in Iowa before making your selection. Here’s a look at the various types of Medicare Advantage plans that may be available to you in Iowa and a brief description of how you access covered health-care services and receive benefits under each plan type.

A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that requires you to use doctors, health-care providers, and hospitals included in your plan’s network to receive benefits for covered services. A Medicare Advantage HMO plan usually will not pay for services you receive from a health-care provider who does not participate in the plan’s network unless you needed emergency care or received pre-approval from the plan to receive treatment outside the network. You may have to get a referral from your primary doctor to receive coverage for certain health services. An HMO Point-of-Service plan, on the other hand, is a more flexible option, allowing you to go out of network for some health services and receive benefits, but generally you pay higher out-of-pocket costs for these covered services than you would pay if you received the services from providers in the plan’s network.

If you prefer a Medicare Advantage plan with more flexibility, you may be able to choose a Preferred Provider Organization (PPO)* plan. In a Medicare Advantage PPO plan, you may choose doctors, health-care providers, and hospitals in or outside of your plan’s network.  Your out-of-pocket costs are typically lower when you receive covered services from providers in the plan’s network.

You may be able to select a Private Fee-for-Service (PFFS) plan, which is a type of Medicare Advantage plan that may include a partial or full network of participating providers.  Keep in mind you should check with the provider to make sure they accept the plan before getting any services.

Another option may be Medicare Advantage Medical Savings Account (MSA) plan, which combines a high deductible with a savings account that you can use to pay for your health care expenses.

If you have specific health conditions, you may want to consider a Medicare Advantage Special Needs Plan (SNP). There are Medicare SNPs for people with certain chronic diseases such as congestive heart failure and HIV/AIDS, those living in nursing homes or other institutions, and people who qualify for both Medicare and Medicaid. A Medicare SNP can offer coverage tailored to an individual’s personal health-care needs.

And if you’re seeking both health and prescription drug coverage, you may want to choose a Medicare Advantage Prescription Drug (MAPD) plan, which combines into a single plan health and prescription drug coverage (also available as a stand-alone Medicare Part D Prescription Drug Plan if you have a Medicare Advantage plan without prescription drug coverage or Original Medicare).

Remember that even if you enroll in a Medicare Advantage plan in Iowa, you have to continue paying your Medicare Part A (if you are not entitled to premium free coverage) and Medicare Part B premiums in order to keep your health coverage.

Comparing Medicare Advantage plans available in Iowa

As a Medicare beneficiary living in Iowa, you may find it useful to compare all the Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans generally varies depending on where you live and which plan you enroll in. You may find that some Medicare Advantage plans in Iowa offer premiums as low as $0, but no matter what premium the plan charges, you must continue paying your Medicare Part B premium.

Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you might want to consider what benefits are important to you, plus whether or not you want prescription drug coverage with your Medicare Advantage policy. With all these options available in Iowa, you can see why it may be smart to compare plans and look for one suited to your personal health and budget needs.

Access the following resources to get more information about Medicare in Iowa:

* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.