Medicare is a federal program that provides health insurance for seniors aged 65 and over, as well as for adults with disabilities. Original Medicare splits its coverage into three parts: A, B and D. Part A is available at no monthly cost to enrollees who have the minimum required work credits and covers the inpatient expenses beneficiaries incur during stays in the hospital. Part B is the optional outpatient benefit that covers medical office visits, transportation services and medically necessary equipment. As of 2023, the basic premium for Part B is $164.90 a month. Part D is also optional and helps cover the cost of prescription drugs at the pharmacy. Premiums vary for Part D, and seniors with low income may qualify for Extra Help.
Medicare Advantage is commonly called Part C because it was adopted before Part D, but it isn’t part of Original Medicare. Instead, it’s an alternative method for enrollees to get their benefits through an approved private insurance company. Part C plans combine all the same coverage as Parts A and B for a single monthly premium. Premium amounts vary by state, risk group and plan, with some plans available in Iowa for $0 a month. Seniors who enroll in Medicare Advantage can save further by skipping unnecessary Medicare supplement (Medigap) premiums.
More than 661,000 people in Iowa are enrolled in Medicare in 2023, a jump of over 29% from 2010. As of July 2023, 71% of enrollees get their benefits via original Medicare, while 33% have chosen one of the state’s authorized Medicare Advantage Plans. This represents a 13.82% jump in Medicare Advantage enrollment from 2022 to 2023. During the same period, Medicare Advantage enrollment grew nationally by just 6.9%. Iowa spends $4.6 billion each year in Medicare, which works out to $6,959 per beneficiary.
This guide goes over the choices seniors have when planning their medical coverage in Iowa. It lists specific costs, describes available benefits and provides helpful resources for older adults and families looking for the health care that best meets their needs.
Original Medicare is still the most popular choice for Iowa residents because it offers basic coverage that meets many peoples’ needs. Some residents may require more comprehensive coverage, however, and have the choice to review alternatives. Medicare Advantage plans and Medigap policies sold by private insurance companies offer ways to bring down out-of-pocket costs and add services not covered by Original Medicare.
Original Medicare is open to seniors aged 65 and over, along with adults who have certain disabilities or end-stage kidney disease (ESRD). Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B pays for medically necessary goods and services.
Seniors generally don’t have to pay a premium for Part A, but Part B does charge a monthly premium that changes from year to year. There’s also an annual deductible of $1,600 for Part A and $226 for Part B in 2023. After this, Medicare covers 80% of costs for eligible services.
Who Should Consider Original Medicare
Original Medicare may be a good option for those who:
Medicare Advantage is an increasingly popular alternative to Original Medicare that combines benefits from Parts A and B into a single plan with one monthly premium. Most plans also include drug coverage and even a few extras that Original Medicare doesn’t pay for, such as dental, vision and hearing aids. Medicare Advantage Plans are issued by private insurers and differ from state to state, but there are similarities in plan structure across providers. Medicare Advantage Plans in Iowa are available as HMOs, PPOs, PFFS plans and SNPs, or special needs plans. Prices and terms for these policies vary by provider.
Who Should Consider Medicare Advantage
Medicare Advantage plans are ideal for seniors who:
The Top 10 Medicare Advantage Plans in Iowa
Iowa residents considering Medicare Advantage have a lot of options to choose from, which could complicate the process of building custom coverage. The following table highlights the top plans in the state based on how many people have enrolled, monthly premiums and estimated out-of-pocket expenses as of August 2023. More information is available on the Medicare Advantage Plans in Iowa page.
|Medicare Star Rating
|Monthly Cost Range
|$0 – $19
|Blue Cross and Blue Shield of IL, NM
|$0 – $59
|Blue Cross Blue Shield of Michigan
|$0 – $34
|$0 – $95
|HealthPartners UnityPoint Health
|$0 – $49
|$0 – $49
|Health Alliance Medicare
|$0 – $165
|Blue Cross and Blue Shield
|$0 – $29
|Wellmark Advantage Health Plan
Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.
Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.
Who Should Consider Medicare Prescription Drug Coverage
Seniors who may benefit from prescription drug coverage include those who:
While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.
For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.
Who Should Consider Medicare Supplement Insurance
Good candidates for Medigap may be those who:
Understanding Medicare benefits and enrolling for coverage is often a complex, confusing process that frustrates seniors who are looking to build the right coverage for their needs. Iowa residents have access to resources to help them review plans, apply for coverage and determine if they qualify for financial assistance programs such as Medicaid. The following organizations offer free assistance and may be able to help in person, over the phone or virtually.
The Social Security Administration publishes guides on its website that help explain Medicare benefits, how to avoid costly penalties and information covering enrollment periods, how to enroll and where to get help. The website also reviews the key differences between Original Medicare and Medicare Advantage plans so that retirees can make informed choices.
The Social Security Administration has a portal where people can apply for Medicare and financial assistance. They can also arrange a meeting with someone in person to review their options.
Senior Medicare Patrol is a non-profit organization that educates seniors on issues regarding health care, Medicare fraud and how to protect themselves against threats such as identity theft. Iowa residents can contact Senior Medicare Patrol if they’re having trouble selecting coverage or need someone to help them apply for benefits. All services are offered free of charge.
The Iowa SHIIP program answers seniors’ questions regarding when and where to enroll in Medicare coverage, whether they’re qualified to receive financial aid and how to find the best Medicare plan for their needs and budget. They work closely with Iowa’s Senior Medicare Patrol to provide virtual and in-person services across the state.
The Iowa Insurance Division provides resources to state residents in many health care matters. Retirees can contact a representative to learn more about their Medicare benefits, to report fraud or file a complaint against an insurance company. The website also offers resources for individuals looking for information about skilled nursing facilities, prescription drug savings plans and life insurance for seniors.
The Iowa Department on Aging connects seniors in Iowa with local organizations that offer educational resources, support services and wellness services. Local offices can assist residents with legal services, health and nutrition programs, medical transportation, senior employment and Medicare assistance. The Department on Aging also offers valuable resources for family caregivers taking care of someone who requires a nursing level of care.