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Top Medicare Advantage Plans in Iowa – 2022 Options

Some of the best Medicare Advantage plans in Iowa for 2022 give Medicare beneficiaries an alternative way to receive their Medicare Part A and Medicare Part B (Original Medicare) benefits. Referred to as Medicare Part C, Medicare Advantage Plans in Iowa cover all of the services covered by Original Medicare.

Medicare Advantage plans might offer additional benefits such as wellness programs, hearing, and routine vision and dental.

What is Medicare Advantage in Iowa?

Medicare Part C, or Medicare Advantage in Iowa, is a type of health insurance that gives Medicare beneficiaries alternative coverage options for Original Medicare.

Those eligible for Medicare benefits can buy Medicare Advantage plans in Iowa from private insurance companies selling them. These Medicare Part C plans cover the same benefits as Medicare Part A (hospital insurance) and Medicare Part B (outpatient medical insurance). Many of the Medicare Advantage plans available in Iowa also offer Medicare Part D (prescription drug coverage) and extra benefits bundled together in one plan.

Here are some features and facts about Medicare Advantage plans:

  • All Medicare Medicare Advantage plans must at least cover all benefits provided by Medicare Part A and Medicare Part B.
  • Private insurance companies selling Medicare Advantage plans must follow Centers for Medicare and Medicaid Services regulations.
  • Part C beneficiaries must also pay their Medicare Part B premiums for coverage eligibility.
  • Medicare Advantage plans in Iowa are very popular coverage options for Medicare benefits.
  • Most Medicare Advantage health plans require enrollees to use healthcare providers that are within the plan’s network.
  • Medicare Advantage Prescription Drug plans (MAPDs) bundle Part D prescription drug coverage with other Medicare benefits in the same plan.
  • Many Medicare Advantage plans provide extra benefits. These can be vision, dental, and/or hearing care; wellness club memberships like SilverSneakers; over-the-counter medications allocations; transportation to and from doctors’ visits; and meal delivery programs.

What is the Best Medicare Advantage plan in Iowa in 2022?

Best for network freedom: Medicare Advantage PPO plans

  • PPOs provide enrolled Medicare beneficiaries with a less limited network for health care services.
  • PPOs don’t require referrals from primary care physicians.
  • Monthly premiums for PPO plans typically range from $0 to $100.00.

Best plan for low out of pocket costs: Medicare Advantage HMOs

  • Most HMOs carry $0 monthly premiums.
  • HMOs require referrals to see specialists.

Best plans for people on a low income or with pre-existing health issues: Medicare Advantage D-SNP

  • D-SNPs, or Dual Eligible Special Needs Plans, cover those who qualify by income level or who have health conditions like end-stage renal disease.
  • D-SNP plans are for people with both Medicare and Medicaid coverage. These plans lower medical expenses for beneficiaries.

What Medicare Advantage plans are available in Iowa?

  • Local HMOs: 11
  • Local PPOs: 16
  • Regional PPOs: 0

What’s changing about Medicare Advantage in Iowa in 2022?

Enhancements to the Medicare Part C and D programs “Beneficiary Real-Time Benefit Tool (BRBT)

This will allow enrollees to:

  • Find lower-cost alternative therapies
  • Compare cost-sharing for prescription drugs to plans that are more cost-effective.
  • Get information about prescription drug prices before purchasing them.

Adding second preferred specialty tier in Part D

These changes will:

  • Help reduce drug prices
  • Help reduce cost-sharing

Medicare Advantage and Part D prescription drug program quality rating system

These enhancements aim to:

  • Have providers make more frequent star rating updates
  • Change calculations and regulations for “Quality Bonus Payment” ratings
  • Change reporting requirements for network pharmacy performance

Implementing several opioid provisions in the SUPPORT act

Medicare prescription drug plan providers must:

  • Begin informing plan beneficiaries about the risks of opioid use.
  • Give enrollees information concerning available alternative treatments for pain relief.
  • Educate and inform enrollees about how to safely dispose of controlled substances such as opioids.

Codifying existing Medicare Part C and Part D program policy for supplemental benefit requirements

  • This enhancement focuses on the reduction of the administrative workload that PACE organizations have.

How much does Medicare Advantage cost in Iowa?

In Iowa, those who are eligible can enroll in an HMO Medicare Advantage plan with a $0.00 monthly premium. There may also be PPO plans with zero monthly premiums, although they are less common.

As of 2021, Iowa Medicare Advantage plans with bundled prescription drug coverage known as MAPDs, have an average monthly premium of $30.94 and average deductibles of $80.75.

 

When can you enroll in a Iowa Medicare Advantage plan?

1. Individual Initial Enrollment Period (IEP)

A. When you are 65 and you are:

  • Receiving retirement benefits from the Social Security Administration Railroad Retirement Board
  • IEP begins three months prior to the month of your 65th birth date.
  • It ends three months after the month of your 65th birth date.

B. If you are under age 65 and you are:

  • On Social Security or Railroad Retirement Board disability for at least 24 months.
  • In this instance, your IEP begins three months before the 25th month and ends three months after the 25th month of your receiving disability benefits.
  • If you have end-stage renal disease or ALS you can enroll in Medicare Advantage earlier.

2. Open Enrollment Period (OEP) or Annual Election Period (AEP)

During AEP people can take the following actions:

  • Enroll in a Medicare Advantage plan
  • Switch from one Part C plan to another
  • Switch from Medicare Advantage back to Original Medicare Part A and Part B
  • Make changes to existing prescription drug plans or enroll in a new Medicare Part D plan

AEP runs from October 15 to December 7, and changes take effect on January 1.

3. Medicare Advantage Open Enrollment Period

During the Medicare Advantage Open Enrollment Period, people can take the following actions:

  • Switch back to Original Medicare
  • Switch from one Part C plan to a different one

The Medicare Advantage Open Enrollment Period runs from January 1st to March 31st every year. Changes take effect the first day of the month following the switch.

4. Special Enrollment Periods (SEP)

During a special enrollment period, people who qualify can enroll in a Medicare Advantage plan with or without prescription drug coverage, or a stand-alone Medicare prescription drug plan.

Qualification for special enrollment periods include:

  • Moving away from your current service area.
  • Moving back to the U.S. after living abroad.
  • Moving into or out of a skilled nursing or long-term care facility or institution.
  • Being released from jail.
  • If Medicare ends a Medicare Advantage plan or changes its coverage. If your Medicaid coverage ends, or if you become eligible for both Medicare and Medicaid coverage.
  • Switching from Original Medicare Part A and Part B plus Medigap to Medicare Advantage.

5. Five-star Special Enrollment Period

If there is a new Medicare Advantage plan with a five-star rating in your service area and you wish to enroll, you can do so during this period.

6. Special Enrollment Period for the “Extra Help” program

If you qualify for Extra Help or Medicaid, you can make changes to your Medicare coverage during the following time periods:

  • January – March
  • April – June
  • July – September

When can I make changes to my Medicare Advantage plan?

The Annual Election Period (AEP) is the most common enrollment period for making changes to Medicare Advantage coverage. Without qualification for special enrollment periods, beneficiaries are locked into Part C plans from January 1 to December 31.

Are Medicare Advantage plans in Iowa “bad”?

Medicare Advantage plans are high-quality, comprehensive insurance plans.

In Iowa, enrollment in Medicare Part C plans is gaining steadily.

The following figures highlight the numbers:

  • Total number of people enrolled in Medicare Advantage plans in Iowa: 113,149
  • The number of people enrolled in Local HMO plans is 38,316
  • The number of people enrolled in Local PPOs is 64,458
  • People enrolled in Regional PPOs: are 0
  • The percentage of Medicare beneficiaries enrolled in Medicare Advantage in Iowa is still low at 27 percent, although it is showing steady growth.
  • The number of people enrolled in Medicare Advantage nationwide is over 26 million.
  • The percentage of Medicare beneficiaries enrolled in Medicare Advantage nationwide is 42 percent.

Common Questions on Medicare Advantage in Iowa

Are there disadvantages to Medicare Advantage?

  • Some Medicare Part C plans have network restrictions that limit the healthcare providers, suppliers, and facilities beneficiaries can use.
  • Some plans ask for referrals from a primary care physician to see specialists.
  • Medicare Supplement, or Medigap, plans are more predictable than Part C plans because they are standardized according to their plan letter. Medigap plans also pay for out-of-pocket expenses like copayments and coinsurance not covered by Medicare benefits.
  • Most Medicare Advantage plans have lower premiums than Medigap, but they have higher out-of-pocket costs.
  • Medicare Advantage enrollees are required to use network providers, pay their copays, their Part B premium, and keep up with other plans to ensure that their coverage meets their health care needs.
  • An insurance company that carries Part C plans can change benefits, provider networks, which prescription drugs they cover, or they can raise premiums. Medigap plans don’t change due to their standardization.

What are the four types of Medicare Advantage policies available in Iowa?

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNP)

Who are the top three Medicare Advantage plan providers in Iowa?

  • United Healthcare
  • Humana
  • Blue Cross Blue Shield

What are Medicare SNPs?

SNP plans offer specialized Medicare coverage for low-income individuals or for those with pre-existing and chronic health conditions.

Do Medicare Advantage plans include prescription drug coverage in Iowa?

Many Medicare Advantage plans in Iowa have additional coverage for Part D plans.

Do Medicare Advantage plans cover the SilverSneakers program in IA?

Many plans have memberships for fitness and wellness clubs like SilverSneakers or other programs.

Related Topics

Iowa State Links

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Key Take Aways
  • In Iowa, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.