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Medicare in Iowa

October 6, 2016

Medicare is a government-sponsored insurance program that offers health insurance coverage for people 65 and over and those under 65 with certain disabilities or chronic diseases. If you’re a Medicare beneficiary in Iowa, you can choose to receive your benefits under Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You may also have the option to enroll in a Medicare approved private health insurance plan under Medicare Advantage (Medicare Part C) or a stand-alone prescription drug plan under Medicare Part D.

Original Medicare for Iowa beneficiaries

As an Iowa resident, you’re eligible for Medicare if:

  • You’re 65 or older.
  • You’re a US citizen or permanent legal resident.
  • You receive disability benefits, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get Medicare regardless of age, if they’re collecting disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board.

You can apply for Medicare through the SSA. If you’re applying for retirement benefits, you can enroll in Medicare at the same time. In Iowa, you can apply:

  • Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use this application.
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778). SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
  • In person at a local Social Security office. To look up office locations in Iowa, click here.

You may enroll in Original Medicare, Part A and/or Part B, in Iowa during the following enrollment periods:

  • Initial Enrollment Period: Your Initial Enrollment Period begins three months before you turn 65, includes your birthday month, and ends three months after your birth month.
  • General Enrollment Period: This period runs from January 1 to March 31 each year, and the effective date of your coverage would be July 1. But be aware that if you miss your Initial Enrollment Period, you may have to pay a late-enrollment penalty in the form of higher monthly premiums.
  • Special Enrollment Period: When you have health coverage through an employer-sponsored health plan, you may be allowed to delay your enrollment in Medicare Part A and/or Medicare Part B without incurring a penalty. You may then sign up for Medicare during a Special Enrollment Period, up to eight months from when your employee coverage ends.

Enrollment in Medicare Part A (hospital insurance) is premium free for most Iowa residents, although in certain cases some individuals may have to pay a monthly premium. Medicare Part A benefits in Iowa include, but are not limited to, the following:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Home health services

Medicare Part B, which is medical insurance, carries a monthly premium. If your annual income is above a certain amount set by Medicare, you may have to pay an additional fee. Medicare Part B in Iowa includes, among others, the following services and supplies:

  • Outpatient doctor visits
  • Outpatient hospital services (such as outpatient surgery)
  • Laboratory services
  • Radiological services (such as x-rays)
  • Ambulance services
  • Durable medical equipment
  • Mental health services
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Medicare coverage options in Iowa

As an Iowa resident, you may choose to receive your Medicare benefits through a Medicare Advantage plan (Medicare Part C), which is provided by private insurance companies approved by Medicare. A Medicare Advantage plan in Iowa, as in the rest of the United States, is required by the government to offer at least the same coverage as Original Medicare, Part A and Part B (except hospice care, which continues to be covered under Part A). Some Medicare Advantage plans also offer extra coverage not available under Original Medicare, such as routine hearing benefits or routine vision coverage.  Some plans, called Medicare Advantage Prescription Drug (MAPD) plans, provide Medicare prescription drug coverage as well as health benefits in a single plan.  If you join a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you’re still required to continue paying your Medicare Part B premium to keep your coverage. You may also have a premium for your Medicare Advantage plan.

As an alternative to a Medicare Advantage Prescription Drug plan, you can receive Part D prescription drug benefits by enrolling in a stand-alone Medicare Prescription Drug Plan in Iowa.  Medicare Prescription Drug Plans are offered by Medicare-approved insurance companies.  They are designed to work alongside your Medicare Part A and/or Part B coverage.  To enroll in a Medicare Prescription Drug Plan you must be enrolled in Part A and/or Part B and live in the plan’s service area.  Premiums for Medicare Part D prescription Drug Plans in Iowa vary, as they do in the rest of the United States, generally depending on the kind of the coverage you choose.

If you decide to stay with Medicare Part A and Medicare Part B for your coverage, you may want to consider enrolling in  a Medicare Supplement (Medigap) plan available in Iowa. Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered by Medicare Part A and Part B.  Medicare Supplement plans offer different standardized benefits (usually identified by a letter—A, B, C, etc.). Medicare Supplement plan premiums vary by the coverage type and the insurance company you choose.  You can also add a Medicare Prescription Drug Plan to your Medicare Part A and Part B and Medicare Supplement insurance to have Medicare prescription drug benefits.  You cannot have a Medicare Supplement plan if you enroll in a Medicare Advantage plan.

Your Medicare coverage options in Iowa will generally vary depending on the county in which you live. For example, if you live in Dubuque County, you may have different Medicare plan offerings than a resident of Cedar Rapids in Linn County. With the various Medicare options available in Iowa, you may want to customize your search for plans based on your individual health needs and preferences.

To get an overview of how Medicare works in Iowa and to learn what plans might be available, see:

Iowa resources for Medicare beneficiaries

  • Medicare beneficiaries in Iowa with Medicare-related issues and concerns can contact the following agency: State Health Departments, 1-866-227-9878, 8AM-4:30PM Monday through Friday, http://idph.iowa.gov/