Any Iowa resident age 65 or older should enroll in the federal Medicare program. Once you enroll, you’ll receive medical coverage benefits from Parts A and B of the Medicare program. Parts A (for hospital stays) and B (for regular doctor visits) are designed to help you manage most of your health care costs. The goal of Medicare is to be comprehensive, so that retirement-age citizens don’t have to worry about expensive health care costs or medical treatment. Unfortunately, there are “gaps” in Original Medicare coverage. If you aren’t careful, they could end up breaking your bank.
Coverage and Benefits
Everyone with Original Medicare will pay a monthly premium and an annual deductible for Part B (prices are shown here). Part A might be free – if you have a long enough employment history. The minimum requirement is 10 years, or 40 quarters. Anything less than that, and you could be paying some fairly expensive premiums in order to get access to your Part A benefits.
There are few things in life that are guaranteed; but for qualifying Medicare recipients, Part A benefits are one of them. As a matter of fact, if you refuse to pay for or accept Part A benefits, you can’t get Medicare, period. Part B, on the other hand, maybe optional. It largely depends on what other types of coverage you would like. Most agree to accept Part A benefits because hospital and hospice treatments are so expensive. Part B benefits typically relate to doctor visits, inpatient treatment, and even some medical supplies.
There are certain situations in which seniors cannot opt out of Part B benefits, though. With Medicare Part C, Part B benefits are a part of that package. They cannot be rejected. Part B is also mandatory if you plan on purchasing Part D prescription coverage. Medicare Part C is a private insurance plan which replaces Original Medicare, and Part D prescription drug coverage is just one of many ways you can get help paying for your prescriptions.
For more information on Original Medicare, see the table below:
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Medicare Insurance Programs in Iowa
At this moment, there are more than half a million people (531,209 to be specific) receiving some form of Medicare benefits within the state of Iowa. Of those, 14% (or 74,369 people) have a Medicare Advantage plan, which we will explain in greater detail later. A significant 48% of Iowa residents (252,843 people) have Original Medicare, and are also supplementing it with a Medigap policy. We will discuss Medigap policies in greater detail also. The remaining 38% of Iowa Medicare beneficiaries either have employment benefit policies which are supplementing their Medicare policies, or they are relying upon Traditional Medicare alone to help cover their health care needs.
Before you go looking for a Medicare supplement, you must first be enrolled in Medicare. For questions about Medicare enrollment, click here.
Why do so Many Iowa Residents Buy a Supplement?
Health care expenses have risen sharply over the past several years. Despite government attempts to make Traditional Medicare as comprehensive as possible, there are still gaps in coverage which require you alone to pay the difference. And if your health care needs fall through one of these coverage gaps, you could end up paying:
|Medicare Part A Costs||Medicare Part B Costs|
Iowa is a great place to live – but like many other states in the Union, it is also an epicenter of rising healthcare costs. unless something changes, these Rising prices will only continue to go up. So what happens for people over the age of 65 who are no longer working, but are suddenly saying more and more expensive Medical costs? Most of them either end up purchasing a Medicare insurance Supplement Plan, or they pay out the nose for their medical care.
As comprehensive as Medicare is, there are certain things it does not pay for. Most senior citizens aren’t aware of these uncovered incidents – also referred to as “gaps” – in their Medicare coverage. if you need an extended Hospital stay, if you need end-of-life care, or even numerous blood transfusions, Medicare won’t cover you. And it will negatively affect whatever retirement finances you have left.
There are ways to protect your savings while also getting the medical care you need to enjoy your golden years. They’re called Medicare supplement plans. Some offer more than others, but it can come at a cost. It’s important to educate yourself about the policies available so that you can get the plan that best meets your needs.
If you want to protect yourself from Medicare coverage gaps, you can choose between a Medicare Advantage plan (AKA Medicare Part C) and a Medigap Insurance supplement. both of these plans come from private insurance companies who want to help you take care of your medical needs. But they are certainly not created equal.
Medigap Supplement Insurance in Iowa
For simplicity’s sake, each one of the ten available Medigap policies are assigned a letter of the alphabet in order to identify them: Plans A, B, C, D, F, G, K, L, M, and N are currently available for purchase in all 50 states. Plans E, H, N, and I are no longer available due to the Medicare Modernization Act of 2010. Plan A in Iowa offers the exact same coverage and benefits as Plan A in California; however, it will likely be cheaper in your state. You will may also have several different underwriters to choose from.
Here are the coverage and benefits options for each plan:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$82||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$109||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$109||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$98||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$78||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$98||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$66||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$83||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$51||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$108||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Iowa Medicare Advantage
If you would like to switch from receiving government Medicare to receiving identical Medicare coverage and benefits from a private health insurance company, then you might want to consider a Medicare Advantage policy. Federal law requires these policies to provide “equal or greater” benefits when compared with Traditional Medicare so that you don’t put yourself at too much of a disadvantage by relying on a private company to help manage your health care needs. Sometimes, Medicare Advantage policies offer extra benefits, like vision or dental, for a minimally higher cost.
One of the ways in which Medicare Advantage policy costs are kept low is via restricted networks. The companies are picky about which doctors and physicians they choose to allow into their HMO and PPO networks, so the doctor you may be seeing now might not be available to you if you switch to a Medicare Advantage plan. This is an important factor to keep in mind if you are thinking about purchasing such a policy.
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are special groups of doctors, hospitals, and facilities through which Medicare Advantage plans provide you with care.
For Iowa: Comparing Medigap and Medicare Advantage
If you want a simple, easy way to protect yourself from Medicare coverage gaps, then Medigap insurance is designed for you. These policies only concern themselves with the gaps in Original Medicare coverage – extended Hospital stay costs, Part B co-pays and coinsurance, foreign travel Care, and More – but don’t necessarily offer you any extra (expensive) bells and whistles.
Medicare Advantage works very differently. If you choose to purchase Part C Medicare coverage, you will have to purchase a package which has the exact same benefits as Parts A&B Original Medicare. From there, you can choose to add coverage which will pay for certain gaps in the base benefits as well as extras like dental or prescription coverage. Just keep in mind that you will be dealing with a private company, and not the government.
There are certain disadvantages which you may want to be aware of before you gravitate towards a Part C plan. For starters, those seniors who are in excellent health and live in areas with many different medical choices tend to get the best value. The more care you need, the more expensive your Medicare Advantage plan will be. You will also have a very limited network if you live in a rural area, or you may need to travel pretty far to get plan-approved medical care.
The differences and similarities between Medigap and Medicare Advantage plans can easily leave even the smartest person confused. But our experts are standing by right now to take your call. We would be more than happy to help you find a quote and get you the best coverage that your money can buy.
There is a lot you need to know about the differences between these two forms of coverage. Read the following table carefully, and make sure to take note of how dissimilar these plans actually are:
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||Your private insurer will quote the government a price based on how much they think your medical expenses will be. The government will pay a percentage – sometimes up to 100% – And whatever is left over is up to you||You are responsible for your monthly premium; beyond that, the costs you will have to pay depend largely on how comprehensive your plan is|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||You may have to pay a monthly premium, and you will likely have to pay the same types of coinsurance, deductibles, and co-pays you would with a normal private health insurance plan||You will have to pay a relatively affordable monthly premium. You may also have partial coinsurance or copayment expenses if you have a less comprehensive plan|
|What will the plan cover?||Medicare Part C starts with the exact same coverages as Medicare Parts A & B. You may choose to add prescription drugs, dental, vision, and gap coverage if you can afford it||Medigap policies are centered around covering the expensive gaps in Original Medicare. The more comprehensive of the policy you choose, the better your coverage|
|Is it easy to budget my health care expenses?||If you are in good health and require very little care, budgeting is easy. But the more care you get, the more expensive and unpredictable it will be||It is simple to budget for the more comprehensive plans – all you need to pay the monthly premium. Less comprehensive plans may require you to pay your Medicare deductibles, coinsurance, and co-pays|
|Is my plan guaranteed? Or can it be cancelled?||As with all private health insurance, your plan may be cancelled at any time and your rates are not guaranteed||As long as you qualify for Medicare, you will qualify for a Medigap supplement policy. the only way you can lose coverage is by failing to pay your premiums or by a financial dissolution of the company|
|Do I have to clear a pre-approval or pre-certification process?||You will have to go through a pre-certification process, and this process is not as easy to qualify for as Medicare is||As long as Medicare is willing to issue you benefits, you can easily qualify for a Medigap Insurance supplements|
|Am I limited to specific doctors or hospitals?||Part of the reason some Medicare Advantage plans are so value-driven is because they restrict their Networks to only the most affordable doctors and hospitals||Medicare and Medigap insurance are accepted by all of the same doctors, hospitals, and outpatient facilities|
|What type of plan is best for me?||If you live in a big city, if you are an excellent house for your age, and if you don’t anticipate frequent healthcare needs, Medicare Advantage may help you out||If you’re older, if you live in a less-populated area, and if you have higher health care needs, a Medigap supplement insurance plan could prove beneficial|
Informative Resources in Iowa
If you still have questions, don’t worry. It’s perfectly normal. Your next step is to have those questions answered by the Medicare professionals near you who know how to provide you with the answers you seek. Consult the following directory, and make sure you get in touch with those who can point you in the right direction.
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Help with my Medicare options & issues
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Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.