Iowa Medicare Guide

Get personalized advice from Medicare advisors who put your interests first. We’ll help you get to know your options, compare pricing and benefits of available plans, and enroll in the best coverage for your needs. Get started by scheduling a free consultation with one of our Iowa Medicare Advisors here or calling us at (888) 604-0055.

In this guide, we break down the basics of Medicare in Iowa to help you understand the options available to you and how and when to enroll.

Use this table of contents to jump to specific sections:

A Snapshot of Medicare in Iowa

There are 647,000 Iowa Medicare beneficiaries, which makes up 20% of the state’s total population. Most Medicare recipients in Iowa are enrolled due to age, but about 11% are on Medicare due to disability. 14% of Medicare beneficiaries are also on Medicaid. We’ll dive into the details of how Medicaid helps low-income Medicare beneficiaries later on.

If you’ve started looking into Medicare or are already on it, you’ve probably heard of Original Medicare, Medigap, and Medicare Advantage. In Iowa, 72% of those on Medicare have chosen to stay on Original (also called Traditional) Medicare. The other 28% are enrolled in a Medicare Advantage plan. Read on to learn about the differences so you can make an informed decision that fits your unique health and financial needs.

Iowa Medicare Eligibility and Enrollment Steps

Every US citizen who meets one of the following criteria is eligible for Medicare:

You’re 65 or older
You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps for Iowa Residents

1. Enroll in Original Medicare (Part A & Part B)

Most people enroll in Medicare due to their age. If this is you, you’re able to enroll up to three months before your birth month, at the start of your Initial Enrollment Period (IEP). Your IEP is a seven-month window of time unique to your birth month. It begins three months before the month you turn 65 and goes until three months after. Some Americans over 65 choose to delay their Part B enrollment because they are still working and receiving employer-linked coverage. If you do this, just be sure you meet all the criteria for a Special Enrollment Period once you stop working and choose to enroll in Part B. You can learn more about this decision here.

2. Compare additional coverage options

We mentioned it in the Iowa Medicare snapshot above, but Medicare beneficiaries have a choice between Medicare Advantage and Original Medicare. We’ll dive into the details of these two programs in the next sections, in addition to information about Part D (prescription drug coverage). This information will help you get a basic understanding of the different options that come with Medicare and which one(s) are best for you. We’re also here to help! Give us a call any time to get personalized advice on Medicare options and plans.

3. Set yourself up for success

Once your Medicare insurance goes into effect, you should use it! Schedule your preventative appointments, update your go-to pharmacy with your new insurance info, and make sure you use any extra benefits if your coverage has them.

In addition to using your Medicare insurance, you should continue to review it each year during the annual Open Enrollment Period. Each year, Medicare Advantage plans, Part D plans, and your healthcare needs may change. The Open Enrollment Period is a good opportunity to explore other options and be sure you’re getting the best value from Medicare.

Iowa Medicare Advantage Plans

There are 50 Medicare Advantage plans available in Iowa. Plan pricing and availability varies from county to county. For example, both Polk County and Plymouth County have 27 plans available, but monthly premiums are as high as $59 in Polk and as high as $130 in Plymouth (in 2023).

One of the reasons Medicare Advantage plans are popular is because many of them have $0 or low premiums. Note: are still responsible for paying your Part B premium, so these plans aren’t entirely free. Still, Medicare Advantage plans offer additional benefits, often with no additional premium. Some of these added benefits include:

Dental, vision, and hearing services
Prescription coverage
Over-the-counter benefit cards
Meals
Fitness perks
Transportation services

More benefits at no extra cost may sound too good to be true, and there is a catch! Medicare Advantage plans also have big disadvantages, including:

Network limitations
Frequent preauthorization requirements
Higher out-of-pocket costs (compared Original Medicare + Medigap)

To hear about and compare pricing and benefits for Medicare Advantage plans available in your county, give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed Iowa Medicare Advisors.

Iowa Medicare Supplement Plans

All Medicare beneficiaries have access to ten different Medicare Supplement (Medigap) plans that are labeled by letter. Each plan of the same letter (e.g., all Plan Gs) are legally required to have the same coverage, but pricing varies based on location and insurance carriers.

Many Iowa Medicare beneficiaries on Original Medicare choose to add a Medigap plan to their insurance coverage. This is because Medigap plans help cover the 20% of costs that Original Medicare doesn’t pay, significantly reducing your out-of-pocket costs. In the case of Plan G, which is generally considered the best Medicare Supplement plan, you don’t owe anything for covered services after meeting your Part B deductible. Compared to Medicare Advantage plans, Medigap plans have some key benefits:

You can see any doctor that accepts Medicare (about 90% of doctors nationwide)
You don’t need prior authorization for covered services
Your out-of-pocket costs are significantly reduced

If you can afford it, it’s generally recommended that you enroll in a Medigap plan during your Medigap Open Enrollment Period, which occurs during the first six months that you have Part B coverage. During this period, you have a guaranteed issue right. This means that insurance companies must accept your application without asking questions about your health history. Outside of this period, unless you qualify for one of a handful of other guaranteed issue periods, insurance companies can ask you questions about your health history and you could be denied Medigap coverage.

Iowa prescription drug (Part D) Plans

Medicare introduced Part D because Original Medicare does not provide prescription drug coverage. Iowa Medicare beneficiaries can either receive Part D benefits through a Medicare Advantage plan that includes them or through a stand-alone Part D plan. There are 24 Iowa Part D plans, but, like Medicare Advantage plans, availability varies from county to county.

We recommend getting Part D coverage even if you don’t currently need it. This is to avoid the Part D penalty if you do need prescription coverage later on.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Iowa Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in Iowa

Healthcare costs can add up. To help low-income individuals receive the healthcare they need, the government has three programs to assist.

Iowa Medicaid for Medicare beneficiaries

Medicaid is a joint federal and state program that is operated by each state. As such, the eligibility requirements and benefits available vary.

Iowa Medicaid is run by the Iowa Department of Health and Human Services and the program is called Iowa Health Link. Iowa has a specific Program of All Inclusive Care for the Elderly (PACE) that’s available to those on Medicaid and/or Medicare. Like all other states, Iowa also has Medicare Savings Programs for Medicare beneficiaries with low incomes and resources.

Iowa Medicare Savings Programs

Even if you’re receiving Medicaid, you should double check that the paperwork has been filed and you are receiving Medicare Savings Program benefits. Additionally, if you income and resources are too high to receive full Medicaid benefits, you should check to see if you’re eligible for assistance from Iowa’s Medicare Savings Programs, which include:

Qualified Medicare Beneficiary (QMB) Program
Specified Low-Income Medicare Beneficiary (SLMB) Program
Medicaid for Employed People with Disabilities (MEPD)

Learn more about the eligibility requirements and application instructions here.

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from Iowa
Iowa pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Iowa Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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