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Best Medicare Advantage Plans in Iowa for 2020

Some of the best Medicare Advantage Plans in Iowa for 2020 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 in Iowa for 2020 might offer additional benefits such as wellness programs, hearing, and routine vision and dental. Here’s a quick comparison of Original Medicare and Medicare Advantage plans.

Original Medicare is through the federal government:

  • Covers Medicare Part A
  • Covers Medicare Part B
  • You can choose your hospital, doctor, and other healthcare providers.
  • You pay a monthly Medicare Part B premium.
  • Deductibles, copayments, and coinsurance apply.
  • You must buy a standalone Medicare Part D prescription drug plan for drug coverage.
  • You can buy a Medicare Supplement health insurance policy to cover coverage gaps left by Medicare Part A and Part B.

Medicare Advantage is through a private insurance company:

  • Covers Medicare Part A and Part B
  • Typically has in-network restrictions for doctors, hospitals, and other providers
  • You may or may not pay monthly premiums for a Medicare Advantage plan in Iowa.
  • You still must pay your Medicare Part B premium.
  • Deductibles, copayments, and coinsurance apply.
  • Medicare Advantage plans generally include prescription drug coverage.
  • You can’t have a Medicare Advantage Plan and also have Medicare Supplement insurance.

Overview of Medicare Advantage Plans in Iowa for 2020

Each insurance company offering Medicare Part C in Iowa for 2020 has a contract with the federal government to administer your Medicare Part A and Part B benefits. These annual contracts may or may not be renewed. As a beneficiary, you need to understand the following before you join a Medicare Advantage Plan in Iowa:

  • You have to live in the service area of the plan.
  • Benefits differ between Medicare Advantage plans.
  • Rules and cost-sharing differ between plans.

You have to be enrolled in Medicare Part A and Part B to qualify for Medicare Advantage. Your Medicare enrollment period starts the three months before your turn 65, includes your birthday month, and ends three months after you turn 65.

If you didn’t enroll when you were initially eligible for Medicare Part A and Medicare Part B, you could join between January 1 and March 31 each year. Late enrollment penalties might apply.

Best Medicare Advantage Plans in Iowa: When Can You Enroll?

There are clear-cut times when you can join, change plans, or drop your Medicare Advantage plan and switch back to Original Medicare. Here are your Medicare Advantage enrollment options:

  • Medicare Initial Coverage Election Period ICEP. Your ICEP is when you’re first eligible for Medicare. The ICEP is a seven-month window that starts three months before you turn 65 and ends three months after you turn 65.
  • Medicare Annual Election Period AEP. Your AEP runs from October 15 through December 7. During your AEP, you can switch between Medicare Advantage plans, change from Medicare Advantage to Medicare Part A and Part B or vice versa, change Medicare prescription drug plans, and enroll in a Medicare Part D plan. The AEP is also frequently called annual enrollment period or fall open enrollment period.
  • Medicare Advantage Disenrollment Period MADP. Before 2019, you could disenroll from Medicare Part C in Iowa between January 1 and February 14. The Medicare Advantage Open Enrollment Period replaces the MADP.
  • Medicare Advantage Open Enrollment Period MA OEP. Your MA OEP runs from January 1 to March 31. During MA OEP, you can change plans or disenroll from your Medicare Advantage plan and return to Original Medicare. You can also request Medicare Part D coverage during this time.
  • Medicare Special Election Periods SEP. SEPs cover life-changing events such as moving out of your plan’s service area, becoming dual-eligible for Medicare and Medicaid services, or if the contract between your Medicare Advantage plan and Medicare changes in some way. The time frame for SEP enrollment varies depending on the reason.

The plan options, costs, and rules can change each year for Iowa Medicare Advantage plans. Your Medicare Annual Election Period AEP is an excellent opportunity to compare your current Medicare Advantage plan with other MA plans to make sure that you’re getting the best coverage, the best value, and the best rates.

Best Types of Medicare Advantage Plans in Iowa for 2020

Beneficiaries have four options for a Medicare Advantage Plan in Iowa. Compare them carefully because your choice affects which hospitals and doctors you see as well as your out-of-pocket expenses. Regardless of the type you choose, you must stay enrolled in Medicare Part A and Part B.

Preferred Provider Organization PPO Plans in Iowa

PPO Medicare Advantage plans:

  • Have provider networks
  • Require no referrals or primary care doctor
  • Cover costs for out-of-network services but at lower rates
  • Apply copays, deductibles, coinsurance, and out-of-pocket maximums
  • Typically cover prescription drugs

Health Maintenance Organization HMO Plans in Iowa

Here’s how HMO Medicare Advantage plans work:

  • Have provider networks
  • Must see in-network providers for HMO to cover costs
  • Requires primary care physician (PCP)
  • Referrals required from PCP
  • Has a deductible, copays, coinsurance, and out-of-pocket maximum
  • Typically cover prescription drugs

Private Fee-for-Service PFFS Plans in Iowa

Under PFFS, the Medicare Advantage plan decides how much it pays providers:

  • Network restrictions might apply
  • No PCPs or referrals
  • Might cover prescription drugs
  • Has a deductible, copays, coinsurance, and out-of-pocket maximum

Special Needs Plans SNPs in Iowa

SNPs must include Part D coverage. A PCP typically coordinates care, and referrals are required. Special Needs Plans are for a beneficiary who meets one of the following conditions:

  • Lives in institutional conditions
  • Is dual-eligible for Medicare and Medicaid
  • Has chronic health conditions such as diabetes, end-stage renal disease ESRD, or heart failure

Enrollment Figures for Iowa Medicare Advantage Plans

Of Iowa’s 3.1 million people, about 17% are Medicare eligible:

  • 87% of beneficiaries qualify due to age
  • 23% have Medicare Advantage or another health plan
  • 60% have enrolled in a PPO

The five largest Iowa counties by population are:

  • Polk
  • Linn
  • Scott
  • Johnson
  • Black Hawk

Do Medicare Advantage Plans in Iowa for 2020 Cover Prescription Drugs?

If you are considering an HMO or PPO and want prescription drug coverage, you have to get benefits through a Medicare Advantage Prescription Drug Plans (MAPD plans). Each MAPD plan has a formulary of drugs it covers. The formulary is divided into prescription drug tiers.

Typically, each insurance company offers four to six prescription drug tiers. Copayments vary depending on the tiers. To get the best coverage and rates, you should carefully compare MAPD plans before enrolling because the formulary, tiers, deductibles, and pharmacy restrictions can be quite different.

If you want to receive your Medicare Part C benefits in Iowa through a PFFS plan, you can buy a standalone Part D policy.

Network Restrictions for Medicare Advantage plan in Iowa for 2020

Iowa Medicare Advantage plans handle network restrictions differently:

  • Out-of-network within the coverage area. PPOs cover out-of-network services whereas HMOs usually do not (except for emergencies).
  • Traveling. Both HMOs and PPOs cover urgently needed care regardless of network.
  • Relocating. Moving across state lines requires you to change plans for the new area and activates an SEP for your new policy.

Added Benefits of Medicare Advantage Plan in Iowa

Many Medicare Advantage Plans in Iowa have $0 premium. However, some insurance companies offer extra benefits such as wellness programs, vision and hearing, and classes to enhance your health. These added benefits typically trigger a monthly premium.

  • Starting in 2020, insurance companies that provide Medicare Advantage plans in Iowa will be able to add some supplemental non-health related benefits to certain beneficiaries, such as providing help with making structural changes to the home when needed. This is designed to help those who might need help with widening doorways or installing ramps for their homes.
  • The Centers for Medicare and Medicaid Services¬†approved a 2.53% payment increase¬†to Medicare insurers that offer Medicare Advantage plans in Iowa.

Top-Rated Companies Offering Medicare Part C Plans in Iowa

You might start by comparing some of the companies that will probably offer Medicare Advantage Plans in Iowa:

  • Aetna: In Iowa, Aetna has tied for a share of about 26 percent of plan members.
  • Humana: Humana has attracted about 18 percent of Medicare Advantage plan members in the past.
  • Coventry: Coventry offers both PPOs and HMOs in some Iowa counties.
  • Senior Preferred: This small insurer has the only plans that earned a 5-star rating for quality from Medicare.

Every year, Medicare keeps track of each Medicare Advantage plan in each county. They use information about customer service, claims to handle, and other quality measures to assign star ratings. Medicare Part C plans in Iowa with a 5-star rating have been pretty rare in the past. However, insurers work hard to improve their quality ratings because they hope to attract more plan members and qualify for extra incentives from the government.

Iowa Medicare Resources

Iowa Medicare Savings Program
CMS Medicare Enrollment Periods
Medicare Advantage Plans in Iowa by County