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Medicare Supplement Plans In Iowa

Getting Medicare coverage often marks an exciting time in people’s lives. It is usually a time of transitioning into retirement. Along with this optimism, though, can come a fair amount of anxiety and worry about making the right enrollment decisions. There’s no doubt that there is reason to be concerned about the costs you’ll face when using your Medicare coverage. However, Medicare Supplement Insurance, one of the most popular private Medicare coverages, is a tool that can greatly reduce your out of pocket spending in Medicare. Read the rest of this short article to gain a better understanding of Medicare Supplement Plans in Iowa.

Why Does Medicare Supplement Insurance Exist?

As mentioned in the introduction, using Medicare benefits can expose you to a significant amount of out of pocket spending. This is an important fact to keep in mind. There is a general perception that Medicare covers everything for you. This isn’t totally true when you consider how much Medicare actually pays. It’s absolutely true that Medicare covers almost all services and procedures that are medically available. What you need to understand is that they won’t cover all of the costs associated with receiving those services. Instead, Medicare was designed to require you to pay a share of the costs for your care. The costs that you’ll have to pay under Original Medicare are known as “gaps”. The gaps that will cost you money are:

  • Part A deductible
  • Part B deductible
  • Part A co-insurance
  • Part B co-insurance (20% of the Medicare-approved cost for all Part B services, once you’ve paid the yearly deductible; this is what most people think of when they think of the costs for Medicare)
  • Part B excess charges
  • Emergency services received outside of the United States (Medicare generally provides no coverage when you’re outside the country)

You’ll encounter some of these costs during the year, even if you only go to the doctor once. Of course, if you need a lot more health care, you can be exposed to all of these costs. Unfortunately, the costs continue to accrue throughout the year; there is no annual maximum protection. Theoretically, your exposure is unlimited. This potential exposure is uncomfortable and unwelcome to most people. Medicare Supplement Insurance helps you deal with these unknowns, protecting you from the gaps in Parts A and B. This is why Medicare Supplement is often called Medigap.

How Does Medicare Supplement Insurance Work?

Medicare Supplement Insurance, or Medigap, is a secondary (supplemental) coverage issued by private insurance companies. As a supplemental coverage, Medigap is highly targeted to helping you pay for Medicare expenses - that’s all it covers. Since Medigap is a secondary coverage, it will only pay after a primary coverage has already paid. In this case, Medicare, Parts A and B, is the primary coverage. In this way, Medigap works hand-in-hand with your Original Medicare benefits. When you go to the doctor you’ll present both cards: your Medicare card and your Medicare Supplement Plan card. Your doctor then bills Medicare as your primary insurance; for a doctor’s visit, that’s a Part B service, so Medicare will pay 80% of the approved amount, assuming you’ve already paid the deductible for the year. Your doctor bills the remaining 20% due to your Medigap plan. Depending on which specific Medigap plan you have (more on this later), your Plan will then pay whatever amount they’re obligated to pay. Most Medigap plans cover 100% of your Part B co-insurance, so if you had one of those, you wouldn't have to pay any part of the doctors’ bill. Medicare Supplement Plans are standardized throughout most of the country. 47 states, including Iowa, have enacted legislation adopting the standardized Medigap plans. There are a total of 11 standardized Medigap plans in existence. They are identified by letter. Each of the 11 standardized plans provides a different coverage level in terms of the gaps covered and costs paid. Since they are standardized, the benefits for each of the plans is the same from one insurance company to another and across all 47 standardized states. The standardization feature allows you to do two things pretty easily:

  • Choose a coverage level you’re comfortable with, and
  • Compare prices for the exact same coverage across multiple insurance companies

Since the coverage is the same regardless of which insurance company you choose, you can easily compare prices.

Who Is Eligible For Medicare Supplement Plans In Iowa?

This is a key question because part of the eligibility rules have been left up to the individual states. Federal regulations require that people who get Medicare coverage at age 65 or later must be allowed to enroll in a Medigap plan when they first become eligible. In addition to this, the premiums are highly regulated for people aged 65 and older. However, there are no federal requirements for people who start Medicare before age 65. Some states have enacted rules that require insurance companies to offer this coverage to the under-65 population. Iowa is not one of these states; Medigap insurers in Iowa are not required to offer Medigap coverage to people younger than 65. Insurance companies are able to do so if they wish, but they’re not required to. This effectively means that Medicare Supplement Plans in Iowa for people under 65 are rare and likely to be very expensive.

How Does Medigap Compare To Medicare Advantage Coverage?

The major choice facing people who enter Medicare is whether to add Medigap to their Part A and B coverage or enroll in a Medicare Advantage Plan. Before comparing the two, let’s first review what Medicare Advantage Plans are. Medicare Advantage is a way to use your Part A and B benefits through a private insurance company, instead of through Original Medicare. In other words, Medicare Advantage is an alternative system to Original Medicare. Your benefits are guaranteed and secure: Medicare Advantage Plans are required to cover everything that Part A and B cover. The difference between Original Medicare and Medicare Advantage is that Medicare Advantage plans provide:

  • An annual Out of Pocket Maximum (OOPM) amount that firmly limits how much you’ll pay in any year (remember that your costs are potentially uncapped with Original Medicare)
  • Mostly fixed co-payments for most services and procedures, unlike Original Medicare where you pay 20% of the cost
  • Extra Benefits like vision, hearing, and dental coverage, which are not available at all from Original Medicare or Medigap
  • In many cases, Medicare Advantage plans come with Part D drug coverage built in

Now that we’ve reviewed what Medicare Advantage is, we’ll review reasons some people might prefer it to Medigap coverage. The two main reasons include:

  • It’s generally more affordable than Medigap coverage
  • It gives help with costs for vision, hearing, and dental which can’t be used with Medigap

For many people, especially those on a fixed income, Medicare Advantage coverage is more affordable and more comprehensive than Medicare plans. On the other hand, there are some reasons why people choose Medigap over Medicare Advantage, including:

  • Medicare Advantage Plans have networks of providers, you often have to stay “in-network,” and many networks don’t cross state lines
  • You will pay co-payments for most services and procedures all year long
  • You often need to get referrals to see specialists

People often choose Medigap over Medicare Advantage if they value the freedom to see any doctor without referral or network restrictions.

FAQ About Medicare Supplement Plans In Iowa

When is the best time to enroll in a Medicare Supplement Plan?

The best time to do this is during your Medigap Open Enrollment Period, which begins when you are BOTH 65 or older AND enrolled in Part B. It lasts for six months.

Can you change Medigap Plans?

In some cases you can. However, if you do this outside of your Open Enrollment Period, you will probably have to answer health related questions, and your coverage might be declined, or you could be charged higher premiums due to your health.

Do Medigap Plans cover prescriptions?

No; you will also need to enroll in a Part D drug plan to go with your Medigap plan.

Do Medigap Plans cover dental, hearing, or vision expenses?

No. To get help with those, you’ll need to look for standalone ancillary coverage.

Can I switch from Medigap to Medicare Advantage?

Yes. You can do this by dropping your Medigap plan and enrolling in a Medicare Advantage plan. You will need to do this during the Annual Election Period, which runs from October 15th to December 7th.

Selection Matters Most When You Choose a Medicare Supplement Plan

Every Medicare Supplement plan with the same plan letter (F, G, etc) offers precisely the same benefits to you, but prices vary widely from one insurer to another. It’s in your best interest to have access to as many plans by as many insurers as possible when you make your Medicare Supplement plan.

That’s where Medicare Consumer comes in. When you speak with our experts you get access to plans from dozens of different insurers. They’ll guide you to the right plan for you at the best possible rate.

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Follow Us for Medicare Updates is a non-government agency and is on a mission to help current and future Medicare recipients find the best Medicare supplement plan for their unique needs. Medicare insurance logos as seen on belong to the respected trademark owners in our available network of Medicare insurance carriers. Any and all rate quotes for Medicare supplement plans are free to consumers and you are not obligated to purchase any plan from any carrier.

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Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a special enrollment period.

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