Iowa Medicare Supplement Plans
If you are an Iowa resident and are turning 65 years old soon, chances are you’ve already started doing your research about your plans post-retirement—healthcare in specific. Apart from the private insurance plans that are available for sale, there are two government-regulated insurance products that are considered as must-haves for any retiring American: Medicare (offered by the state) and Medicare Supplement (offered by the state through private companies).
Whether or not you have saved some money for your retirement, you will need to have a healthcare policy that will more or less guarantee that your future expenses will not eat into your hard-earned savings. Even if you have set aside a considerable sum, having a health plan to address any forthcoming medical costs is a practical and smart choice.
In Iowa, there are plenty of private insurance agencies that offer Medigap plans, but with varying pricing schemes and add-on benefits. Before shopping around for the right policy for you, let’s first talk about the basic benefits you get out of Medicare and Medicare Supplements.
Basics of Medicare
Medicare is directly issued by the US government and is composed of two products: Part A (hospital insurance) and Part B (medical insurance), with the breakdown of benefits as follows:
Part A
- Inpatient hospital expenses
- Skilled nursing facility care
- Home health care (medically necessary skilled care and therapy)
- Hospice care for the terminally ill
- Blood (first 3 pints)
Part B
- Outpatient hospital and emergency room expenses
- Doctor’s fees
- Home health care (medically necessary skilled care and therapy)
- Durable medical equipment (ex. blood sugar monitors and test strips, commode chairs, canes, crutches, hospital beds, CPAP devices, etc.)
- Other services and supplies
Those who have been part of the workforce for most of their lives pre-retirement are likely to get Medicare Part A for free, while Medicare Part B comes with a monthly premium that depends on your modified adjusted gross income. For example, for the year 2021, those who are earning less than $88,000 individually are set to pay $148.50 in Part B premiums, while those who file an ITR of more than $500,000 pay $504.90 per month.
Medicare Supplements Benefits
Because the government cannot possibly shoulder all the medical expenses on its own, it created Medicare Supplement Insurance (also called Medigap) as a way to fill the gaps and somehow alleviate the burden of spending.
However, although Medigap is government-regulated, it is sold through private insurance companies and, naturally, come with an additional monthly cost. If your employer provides insurance or you are eligible for Medicaid assisted programs, you will not need to acquire a Medigap plan. The same goes if you have a Medicare Advantage plan.
Note that you will need only one Medicare Supplement plan, and insurance companies in Iowa are limited to selling the 10 plans that the government identifies in letters: A, B, C, D, F, G, K, L, M, and N. Private providers can opt to sell all 10 or select only a few that they feel would be the most in demand.
Benefits | A | B | C | D | F* | G | K | L | M | N |
Part A coinsurance and hospital expenses(up to 365 days after Medicare benefits are used up) | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Part B copayment or coinsurance | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
First 3 pints of Blood | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
Part A hospice care copayment or coinsurance | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
Skilled nursing facility care coinsurance | x | x | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
Part A deductible | x | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
Part B deductible | x | x | 100% | x | 100% | x | x | x | x | x |
Part B excess charges | x | x | x | x | 100% | 100% | x | x | x | x |
Foreign travel emergency expenses(based on plan limits) | x | x | 80% | 80% | 80% | 80% | x | x | 80% | 80% |
Pre-existing Conditions
If you have a pre-existing health condition, you can still qualify for Medigap under a six-month maximum waiting period before benefits are paid. You can avoid this if you are in your OEP (Open Enrollment Period) and you apply for Medigap within 63 days of the end of your previous health plan. Other ways to avoid the waiting time is when you lose healthcare benefits or if you apply for another Medigap plan to replace the one you’ve had for at least six months.
Open Enrollment Period (OEP)
Every new Medicare beneficiary has a guaranteed right to purchase any Medigap plan during a six-month OEP, which starts when you are 65 years old and enroll in Medicare Part B for the first time.
If you apply for Medigap at this time, the agency cannot reject your application or charge you more than anybody else in your age group. However, if you miss this period and apply only after the six months have passed, then some companies might refuse to approve your application due to health reasons.
Guaranteed Issue Rights
Outside of your OEP, there is still a way to guarantee approval for your application. A “guarantee issue” means that the insurance provider will not consider your health status, though it may charge a higher premium or require a waiting period. During which case, you must enroll in your preferred Medigap policy within 63 days. There are certain situations that will give rise to special rulings for such to be activated, as follows.
1. Your employer placed you under a group health benefit program that still provides benefits after Medicare and this plan stops providing all or some of your entitlements.
2. You previously had Medicare Select, Medicare Advantage, and Medicare Cost BUT disenrolled because you moved to another area, the plan halted providing Medicare service, or the plan was is violation of the contact or was misrepresented with false marketing.
3. You had a Medigap plan but this had to end because either the insurance provider became bankrupt, the coverage involuntarily stopped, or the plan was in violation of the contract or was mis-marketed.
4. You have a Medigap policy but you stopped this to enroll into Medicare Select, Cost or Advantage for the first time and then you disenroll from such during the first 12 months.
Medicare Supplements in Iowa
Iowa-based insurance providers sell the ten standardized Medigap plans, plus the high deductible versions of Plan F and G. The benefits covered by each are the same with every company, but their monthly premium fees will be different.
Plus, there are companies that provide additional innovative benefits to sweeten the deal. Note that Iowa insurance agencies are not allowed to simply place add-ons to their Medigap offerings—their “deals” must be approved by the Iowa Insurance Division for these to be valid.
Before Buying a Medigap Plan in Iowa
Before purchasing any Medicare Supplement insurance policy there are several things you should understand:
- You should already be enrolled in Medicare Part AND Part B before you can quality for any Medigap policy
- If you purchase a Medigap plan, know that it will be an additional expense. You will pay a monthly premium (price depending on your chosen provider) in addition to the monthly fee that you are paying for Medicare Part B.
- Medigap covers just one person, so if you are married, you and your spouse will need to purchase a plan separately (can be different).
- Medigap Plans C and F will not be available to those who become eligible for Medicare on or after January 1, 2020. However, if you have already been covered prior to this date, then you can continue enjoying your original benefits.
- You cannot have drug coverage in both your Medicare drug plan and Medigap; just choose one.
Pricing Reference
The going rate for Medicare Supplement Plan A (the most basic policy) in Iowa ranges from $1,145 to $4,900 per year (effective February 1, 2021). The price varies according to the provider, whether the applicant is male or female, is a smoker, or is applying for a household discount. Check your shortlist of Medigap providers for their specific rates and pricing schemes.
In addition, Iowa insurance companies also offer Medicare Supplement products to those who are not 65 years old but have a disability or ESRD. However, same with most states, if you are entering Medicare because of a handicap, then you will not qualify for OEP. However, when you do reach the age of 65, you will still be entitled for the six-month open enrollment period opportunity and can make a switch if you want to.
Need Help?
If you’re still unsure which type of Medicare Supplement plan you need, our team of Medigap specialists can assist in making that decision by helping you ask the right questions. What are the exact premiums for the plan you are considering? Does the agency offer a lower premium if you are in good health? Does it offer a household or group discount? These are just some of the pertinent questions to ask when shopping for the right Iowa Medicare Supplement provider. Please don’t hesitate to get in touch with us at 1-800-791-0150 so we can help get you on the right path.
