Medicare plays a key role in providing health and financial security to beneficiaries residing in Iowa. With more than 633,900 Iowa beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Iowa. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Iowa?

Medicare covers most Iowa residents who are 65 or older, and it also covers disabled Iowa residents. In general, Medicare enrollment in Iowa works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Iowa Medicare Enrollments

474,948

Original Medicare Plans
(Part A and B)

158,987

Medicare Advantage & Other Health Plans

502,252

Stand-alone Medicare
Part D (Drug plans)

633,935

Total Medicare Beneficiaries
in Iowa

Iowa Medicare Advantage Plans (Part C)

Only 23% of Iowa Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Iowa who are already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Most Iowa Medicare beneficiaries choose Original Medicare for their coverage rather than Medicare Advantage plans. In fact, Taylor County in Iowa doesn’t have Medicare Advantage plans available so residents must use Original Medicare instead. The other 98 counties in Iowa have between two and 20 Medicare Advantage plans available for enrollment.

As of 2020, 39 Medicare Advantage plans are available in Iowa. The average monthly Medicare Advantage premium in Iowa changed from $10.28 in 2019 to $9.71 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Iowa. 97% of people with Medicare have access to a Medicare Advantage plan. According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 158,987 beneficiaries enrolled in Medicare Advantage and other plans in Iowa.

Iowa Medicare Supplement (Medigap) Insurance Plans

Iowa doesn’t require insurers to offer Medigap plans to people under 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B.

During this period, an insurance company can’t use medical underwriting. 

Iowa doesn’t require insurance companies offering Medigap plans to offer these plans to people under 65 years old. As of 2020, updates to Chapter 37 include adjustments to comply with federal rules for Medigap plans when newly-eligible enrollees are no longer able to buy Medigap plans that cover the Part B deductible. The revised Iowa code is Rule 191-37.9. Medigap insurers in Iowa are required to spend at least 65% of premiums (75% for group plans) on benefits for enrollees, as opposed to administrative costs.

Iowa Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, there are 374,932 Medicare beneficiaries in Iowa enrolled in stand-alone Part D prescription drug plans and 128,230 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 29 stand-alone Part D plans available in Iowa, with premiums ranging from about $15 to $94 per month.

Nearly 88% of people with a stand-alone Medicare prescription drug plan have access to a plan with a lower premium than what they paid in 2019. About 20% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Iowa

  • Senior Health Insurance Information Program (SHIIP) – Senior Medicare Patrol (SMP): SHIIP advocates for, informs, educates, and assists consumers on Medicare and related health insurance issues so they can make informed decisions and access resources to address their needs. SHIIP also helps people of Medicare apply for assistance with their Part A and Part B premiums, copays and coinsurance, and prescription drug costs. SMP empowers and assists Medicare beneficiaries, their families, and caregivers to prevent, detect, and report healthcare fraud, errors, and abuse.
    Contact: Call 800-351-4664

  • The Iowa Department on Aging strives to improve the quality of life and care of older Iowans through advocacy, planning, policy development, and the administration and support of statewide programs and services that promote health, safety, and long-term independence. This “aging network” is designed to serve all Iowans who are 60 and older, with particular emphasis on populations demonstrating the greatest social or economic need. With projections for Iowa’s population aged 65+ to grow to constitute 19.9 percent of the state’s total population by 2050, the Department focuses on empowering older adults to maintain their independence and advocates on behalf of older Iowans to ensure their rights, safety, and overall well-being.
    Contact: Call toll-free at 800-532-3213 or locally at 515-725-3333

  • Aging Resources of Central Iowa is a senior-specific agency serving Boone, Dallas, Jasper, Madison, Marion, Polk, Story and Warren counties. Milestones Area Agency on Aging is committed to working with communities and community-based organizations to increase awareness for aging successfully with dignity and independence. They do this by implementing policy with public resources provided by the Federal Administration on Aging and the Iowa Department on Aging.
    Contact: Call 515-255-1310 or 800-747-5352. The Information and Assistance hotline can be reached by calling 515-255-1310 or via email at [email protected]

  • The Northeast Iowa Area Agency on Aging, or NEI3A, serves Allamakee, Black Hawk, Bremer, Buchanan, Butler, Chickasaw, Clayton, Delaware, Dubuque, Fayette, Grundy, Hardin, Howard, Jackson, Marshall, Poweshiek, Tama and Winneshiek counties. NEI3A coordinates services for individuals to help them maintain the independence they desire. Services they provide include option counseling, case management, meal programs, caregiver support, respite services, evidence-based health programs, advocacy, and recreation and education programs.
    Contact: Call 800-779-8707 or complete a request for information form on the organization’s website.

  • Elderbridge Agency on Aging serves 29 counties across North Central, Northwest, and Central Iowa. Elderbridge Agency on Aging is part of a national network designed to address the needs and concerns of older adults. Their mission is to advocate for and empower older adults, caregivers, and individuals with disabilities to pursue independent healthy lives.
    Contact: Call Elderbridge at 800-243-0678 or 641-424-0678 for the Mason City office, 515-955-5244 for the Fort Dodge office, 712-792-3512 for the Caroll office or 712-262-1775 for the Spencer office.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Iowa. Our process makes it easier for you to access your Medicare eligibility in Iowa so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 382-1192 anytime to get a free quote or to ask any questions.

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