Benefit Options When You Have Medicare
Original Medicare with Supplemental Insurance
With Original Medicare you share in the cost of your health care. Most people like to have supplemental insurance to pay some deductible and coinsurance amounts.
Medicare Supplement Policies
A small number of insurance companies sell Medicare supplement policies to those under age 65 who have Medicare. These companies are listed in the current Iowa Medicare Supplement & Premium Comparison Guide available from SHIIP at 1-800-351-4664. A few of the plans available are guarantee issue. That means they won’t turn you down; however, these plans may be expensive.
You don’t have an open enrollment for Medicare supplement policies when you are under age 65. However, at age 65 you will have a six-month open enrollment period. Then, you can’t be turned down for any plan being sold. You can’t be charged a higher premium because of any health conditions.
If you become covered by an employer group health plan, you can suspend your Medicare supplement policy indefinitely.
Employer Insurance
If you continue to be covered under an employer group health plan after you or your family member quits working, the employer plan can supplement Medicare. It will pay after Medicare pays. These plans may have drug coverage and other benefits not available in Medicare supplement policies. Please view COBRA for additional information.
Other Medicare Choices
You may choose to receive your Medicare Part A and Part B benefits including Medicare prescription drug coverage through a Medicare Advantage plan instead of Original Medicare. The plan has a contract with Medicare to handle your Medicare benefits for you.
Medicare Advantage plans cover all the same services as Original Medicare. Plans often cover additional services such as routine physicals, hearing and vision services.
Some plans require you to pay a premium to the plan; others have no premium. Benefits begin from the first day the plan is effective for you.
Plans operate in different ways, and your costs with each plan will differ. You may pay a deductible, a set copayment amount or a percentage of the cost for services. You do not need to pay for a Medicare supplement when enrolled in one of these Medicare health plans and the Supplement will not pay.
A Medicare Advantage plan has to take you if you are on Medicare because of disability, you have both Medicare Part A and Part B and you do not have permanent kidney failure.
Medicare Advantage plans are available in most counties in Iowa except Dubuque and Taylor. Medicare beneficiaries who live in one of these counties do not have the option of enrolling in a Medicare Advantage plan.
There are several different types of Medicare Advantage plans in Iowa including: Health Maintenance Organization (HMO) and HMO with Point-of-Service (HMO-POS), Preferred Provider Organization (PPO), Private Fee-For-Service (PFFS) and Special Needs Plans (SNP).
Medicare Cost plan is another choice to provide your Medicare benefits and is available in 67 counties in Iowa. This plan has a network of providers. When you use plan providers the services you receive are billed to the Cost Plan. When you do not use plan providers Medicare will pay.
Call SHIIP-SMP at 1-800-351-4664 for questions or review our Medicare Advantage & Other Health Plans in Iowa Guide. This guide includes basic information to help you understand the Medicare Advantage and Cost plan choices in Iowa.
Medicare and the Health Insurance Marketplace
During the 24-month waiting period, before your Medicare starts, you can apply for coverage in the Marketplace. If you stay with your Marketplace plan once your Part A coverage starts any premium tax credits and reduced cost-sharing will stop. Your policy may pay little or no benefits once you are enrolled in Medicare. Check your policy. You may also face penalties if you delay enrolling in Medicare Part B and Part D at this time. Contact SHIIP-SMP to review your Medicare and health insurance options before your Medicare coverage starts.
HIPIOWA
A Health Insurance Plan of Iowa policy is available to individuals unable to buy health insurance due to health reasons. These policies can be used as a supplement to Medicare for individuals under 65. For more information call the State of Iowa Insurance Division at 1-877-955-1212.
If You Go Back to Work
Continued Eligibility for Medicare Part A
You may remain eligible for Medicare Part A if you go back to work, as long as you are considered disabled. Part A will be premium-free for up to 8 ½ years; after 8 ½ years you can continue Medicare Part A by paying the premium. Medicaid may pay that premium if your income is below 200% of the federal poverty level.
You can continue to be enrolled and pay the premium for Medicare Part B as long as you are enrolled in Part A. If you have employer health benefits and don’t need Part B, you may be able to drop it and enroll later if necessary. Call your local Social Security Office with questions.
Medicaid for Employed Persons with Disabilities
This program allows those under age 65 with disabilities to work and to have access to Medicaid assistance. You must have earned income from employment.
Eligibility is based on net family income and must be less than 250% of the federal poverty level. Call your local Department of Human Services office to see if you are eligible