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.
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.
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)
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.
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|
Fortunately, there are a number of flexible and affordable options when it comes to supplementing Medicare with an additional or an alternate insurance policy. The two most common supplements are Medicare Advantage (sometimes called Medicare Part C), and Medigap insurance (because it is designed to cover the “gaps” in Medicare). Keep reading for more information on each plan, and to learn why they are so popular.
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:
|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|
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. Here are some HMO and PPO networks near you:
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating||There are no plans to show|
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating||There are no plans to show|
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 the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
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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