Human Resources
State of Iowa Health Insurance and Medicare
This following information explains how the State of Iowa health insurance interacts with Medicare.
* SHIIP is a a free, confidential service of the Iowa Department of Insurance that helps Iowans make informed decisions about Medicare and other health coverage.
Overview of Medicare
You are eligible for Medicare when you are:
- Age 65
- Under age 65 with certain disabilities
- Any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
As either a State of Iowa active employee or retiree enrolled in a state-sponsored health insurance plan, there are three parts of Medicare that could affect you.
Medicare Part A
This is hospital insurance that helps pay for inpatient care in a hospital or skilled nursing facility following a hospital stay, some home health care, and hospice care. There is no cost for Medicare Part A as long as you are eligible for the Social Security benefit.
Medicare Part B
This helps cover medically-necessary services like doctors’ services, outpatient care, and other medical services that Part A does not cover. Part B also covers some preventive services. Most people will pay the standard monthly premium for Medicare Part B.
Medicare Part D
This provides prescription drug coverage. More information about Medicare Part D and the State of Iowa's health plans can be found at the SilverScript website.
When you retire, and move from being an active employee to a retired employee staying on the State of Iowa's retiree insurance, anyone who is eligible for Medicare should enroll in Medicare Parts A and B. Failure to enroll in Medicare Parts A and B may result in a penalty from Medicare and a difference in the payments of claims from Wellmark.
General information is available at the Social Security and Medicare websites.
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Coordination of Benefits between State of Iowa Health Plans & Medicare
Whether the State of Iowa health plan or Medicare will be primary or secondary coverage is dictated by the status of the State of Iowa health plan contract holder. If the contact holder is working for the State, regardless of their age, the State of Iowa health plan will be primary to Medicare unless the active employee or active employee’s spouse chooses to have Medicare as their primary coverage. In that case for an active employee, the Medicare eligible person would be removed from coverage with the active group.
| If you are: | And your age is: | Which plan pays first for you? |
The Contract Holder is an Active Employee |
||
| The Employee | Any age | The State of Iowa plan |
| Spouse of the Employee | Any age | The State of Iowa plan |
| Domestic Partner | Any age | The State of Iowa plan |
The Contract Holder is a Retiree |
||
| The Retiree | Under age 65 | The State of Iowa plan |
| Spouse of the Retiree | Under age 65 | The State of Iowa plan |
| Domestic Partner | Under age 65 | The State of Iowa plan |
| The Retiree | Over age 65 | Medicare |
| Spouse of the Retiree | Over age 65 | Medicare |
| Domestic Partner | Over age 65 | Medicare |
When the contact holder retires, and moves from being an active employee to a retiree staying on the State of Iowa's retiree health plan, anyone who is eligible for Medicare should enroll in Medicare Parts A and B. Failure to enroll in Medicare Parts A and B may result in a penalty from Medicare and a difference in the payments of claims from Wellmark.
In certain medical circumstances, such as being diagnosed with End Stage Renal Disease, the employer group plan will be primary to Medicare for a period of time even when you are on retiree coverage. You should consult Medicare guidelines regarding your specific situation.
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Active Employee
If you or your spouse/domestic partner is an active employee and enrolled in a State of Iowa health plan, the State’s health plan will continue to be your primary insurance. You or your spouse/domestic partner should enroll in Medicare Part A effective on the first of the month in which you turn age 65. However, if your 65th birthday falls on the first day of the month, then Medicare Part A should be effective on the first day of the preceding month. There is an election form that the State of Iowa will send you along with further information near the time of you or your spouse’s/domestic partner’s 65th birthday. If Medicare is chosen to be the primary insurance, you will no longer be covered by the State of Iowa health care program.
Medicare A is generally at no cost to you and may supplement your State of Iowa health plan if you are hospitalized. You or your spouse/domestic partner may delay enrolling in Medicare Part B until you retire from the State of Iowa. There is a monthly premium for Medicare Part B and you do not need this coverage until you retire. In addition, while you are actively employed, it is not necessary to be enrolled in SilverScript (the State-sponsored Medicare Part D program). Your State of Iowa health plan will cover prescription benefits.
If you or your spouse/domestic partner receive benefits from Social Security, you will automatically get Parts A and B. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If the card shows both Medicare Parts A and B coverage, follow the instructions to delay Medicare Part B and keep Medicare Part A. You or your spouse/domestic partner will be mailed an updated card that shows just Medicare Part A coverage. Send a copy of this card to your agency’s personnel assistant to ensure coordination of benefits.
If you or your spouse/domestic partner are not receiving Social Security, you will need to sign up for Part A. You should contact your local Social Security Administration office 3 months before you turn age 65 to sign up for Medicare Part A.
In order to avoid penalties, we suggest you or your spouse/domestic partner contact the Social Security office to inform them that you have primary coverage through the State of Iowa and do not need Medicare Part B at this time.
Active Employee Age 65 or Older Preparing to Retire
You should already be enrolled in Medicare Part A effective when you turned age 65. Contact your local Social Security office 3 months prior to your retirement date to determine your Medicare eligibility and to enroll in Medicare Part B. Advise the representative that you have been working past age 65 and that your Medicare B coverage should be effective the first day of the month following your retirement date. The State of Iowa health insurance will continue to provide you prescription drug coverage. You may wish to explore the possibility of enrolling in SilverScript, the Medicare Part D plan that coordinates on pharmacy coverage with the State of Iowa health plan for a further reduced Wellmark monthly premium. In order to get the lowest possible Wellmark premium, all Medicare-eligible dependents must enroll in SilverScript.
When you retire, and move from being an active employee to a retired employee staying on the State of Iowa's retiree insurance, anyone who is eligible for Medicare should enroll in Medicare Parts A and B. Failure to enroll in Medicare Parts A and B may result in a penalty from Medicare and a difference in the payments of claims from Wellmark.
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Retiree Turning Age 65
If you are retired and enrolled in a State of Iowa health plan, Medicare Parts A and B will become primary insurance for you and/or your spouse/domestic partner on the first of the month when you turn age 65. However, if your 65th birthday falls on the first day of the month, then Medicare Parts A and B should be effective on the first day of the preceding month. If you continue on a State of Iowa health plan, it will continue as a Medicare carve-out policy with the same benefits and will pay secondary to Medicare Parts A and B. The State of Iowa health insurance will continue to provide you prescription drug coverage. You may wish to explore the possibility of enrolling in SilverScript, the Medicare Part D plan that coordinates on pharmacy coverage with the State of Iowa health plan for a further reduced Wellmark monthly premium. In order to get the lowest possible Wellmark premium, all Medicare-eligible dependents must enroll in SilverScript. If you want to cancel your State of Iowa health insurance, contact Wellmark customer service for information on how to cancel your insurance plan.
If you get benefits from Social Security, you will automatically get Medicare Parts A and B. Your Medicare card will be mailed to you about 3 months before your 65th birthday. Contact Wellmark customer service to let them know of your Medicare enrollment. If the State of Iowa is paying any portion of your health insurance premiums either through the Sick Leave Insurance Program (SLIP) or State Employee Retirement Incentive Program (SERIP) program, please contact DAS-HRE at 515-281-6124 to inform them of your Medicare enrollment.
If you are not receiving Social Security benefits, you will need to sign up for Parts A and B. You should contact your local Social Security Administration office 3 months before you turn age 65 to sign up for Medicare Parts A and B. Contact Wellmark customer service to let them know of your Medicare enrollment. If the State of Iowa is paying any portion of your health insurance premiums either through the Sick Leave Insurance Program (SLIP) or State Employee Retirement Incentive Program (SERIP) program, please contact DAS-HRE at 515-281-6124 to inform them of your Medicare enrollment.
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Disability
Active Employee or Dependent, Spouse/Domestic Partner Medicare-Eligible Due to Disability
If you, your dependent or spouse/domestic partner who is enrolled under your active employee State of Iowa health plan, become eligible for Medicare due to a disability, your health plan will continue to be the primary insurance. The Medicare-eligible person should enroll in Medicare Part A. This will have no cost to them and would supplement your State of Iowa health plan if the disabled person is hospitalized. The disabled person may delay enrolling in Medicare Part B until they are no longer on your health plan or you terminate your employment with the State. There is a monthly premium for Medicare B and this coverage should not be needed while covered on a health plan due to your active employment with the State. In addition, while you are actively employed, it is not necessary to be enrolled in SilverScript the Medicare Part D plan for pharmacy services. Your State of Iowa health plan will cover prescription benefits.
If the reason for disability is due to End Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant), there are some other criteria to follow. Please see your personnel assistant for more details if this is the cause for Medicare-eligibility due to disability.
If your dependent or spouse/domestic partner receives benefits from Social Security due to disability, they will automatically be mailed a Medicare card about 2 months before they become eligible. If the card shows both Medicare A and B coverage, follow the instructions to delay Medicare B and keep Medicare A. An updated card will be mailed that shows just Medicare A coverage. Send a copy of this card to your agency’s personnel assistant to ensure coordination of benefits.
If you want to stop health coverage for the disabled dependent or spouse/domestic partner, you should contact Social Security to ask about Medicare eligibility and contact your agency’s personnel assistant to make your changes to your insurance coverage. A change can only be made according to the guidelines for changes due to a qualifying life event or during the annual enrollment and change period.
Retiree with Medicare Due to Disability
If you become eligible for Medicare, due to disability while enrolled in a State of Iowa health plan, Medicare Parts A and B will be your primary insurance. You may continue the State of Iowa health plan as a Medicare carve-out policy and it will pay secondary to Medicare Parts A and B. You may wish to explore the possibility of enrolling in SilverScript, the Medicare Part D plan that coordinates on pharmacy coverage with the State of Iowa health plan for a further reduced Wellmark monthly premium. In order to get the lowest possible Wellmark premium, all Medicare-eligible dependents must enroll in SilverScript. Contact Wellmark customer service to let them know of your Medicare enrollment. If the State of Iowa is paying any portion of your health insurance premiums either through the Sick Leave Insurance Program (SLIP) or State Employee Retirement Incentive Program (SERIP) program, please contact DAS-HRE at 515-281-6124 to inform them of your Medicare enrollment.
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Last updated 06/22/2011