What Are Medicare Advantage Plans in Iowa?

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans include Part A (hospital insurance) and Part B (medical insurance), and most also include Part D (prescription drug coverage). Many plans offer additional benefits like dental, vision, hearing, fitness programs, and telehealth services.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but younger individuals may qualify due to disability, ALS, or ESRD. Enrollment is available during the Initial, General, and Special Enrollment Periods. Be aware of late enrollment penalties or premium requirements if you don’t qualify for premium-free coverage.

What Types of Medicare Advantage Plans Are Available in Iowa?

Iowa offers the following Medicare Advantage plan types:

• Health Maintenance Organizations (HMOs): Require in-network providers; referrals typically needed for specialists.
• Preferred Provider Organizations (PPOs): Allow out-of-network care at higher costs; usually no referrals needed.
• Private Fee-for-Service (PFFS) Plans: Let you visit any provider who accepts your plan’s terms.
• Special Needs Plans (SNPs):
  • I-SNPs: For individuals in institutions or needing nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid, often including drug coverage, dental, and care coordination at little to no cost.

Note: Iowa currently does not offer Chronic Condition SNPs (C-SNPs) or Medicare Medical Savings Accounts (MSAs).

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, if you’re enrolled in a PFFS plan or an MSA plan that doesn’t include drug coverage, you may:

• Enroll in a separate Part D plan (if eligible),
• Face a late enrollment penalty if you delay obtaining creditable coverage.

Always verify that your medications are included in the plan’s formulary.

How Do You Choose a Medicare Advantage Plan?

Use this guide to understand Medicare Advantage costs before choosing:

• Premiums: Many plans offer $0 premiums; others charge a monthly amount.
• Deductibles, Coinsurance & Copays: Out-of-pocket expenses vary by plan.
• Out-of-Pocket Maximums: Limits your annual expenses for covered services.
• Extra Benefits: Plans may include dental, vision, hearing, fitness memberships, telehealth, and OTC allowances.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: Starts 3 months before and ends 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop plans.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Medicare Part B.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by major life changes such as:
  • Moving out of your plan’s service area
  • Loss of employer or union coverage
  • Plan termination
  • Newly qualifying for an SNP

What If You Want to Change Your Medicare Advantage Plan?

You can change your plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Your new coverage will automatically replace the previous one.

What Are Medicare Resources in Iowa?

Iowa offers several free or low-cost programs to help with Medicare:

• Iowa SHIIP (Senior Health Insurance Information Program): Offers free counseling. Learn more.
• Iowa SMP (Senior Medicare Patrol): Educates about Medicare fraud. Learn more.
• Iowa Insurance Division: Regulates insurance plans and handles complaints. Visit site.

For low-income residents, Iowa Medicaid may help with medical costs. Visit Iowa Medicaid or call 1-800-338-8366. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover costs that Original Medicare doesn’t pay, like copayments, coinsurance, and deductibles.

You must have Parts A and B to qualify. The best time to enroll is during your six-month Medigap Open Enrollment Period, when you can’t be denied coverage for preexisting conditions. Outside of this window, acceptance is subject to underwriting.

Medigap doesn’t cover prescription drugs, so you’ll need a separate Part D plan. There are 10 standardized plans; Plans G and N are among the most popular. Medicare Supplement Plan G had the highest enrollment in 2023.

Learn more about Medicare Supplement Plans in Iowa.

Next Steps

If a Medicare Advantage plan in Iowa is right for you, compare available options in your ZIP code. Check provider networks, prescription coverage, and out-of-pocket costs. Be ready to enroll during an eligible enrollment period.