Human Resources
Health Insurance for Medicare-Eligible Retirees
You can continue your health coverage with the State of Iowa when you become eligible for Medicare.
| Quick Access to this Site |
| Medicare |
| Medicare-Eligibility and SLIP Dollars |
| Medicare Supplement Plan |
| Medicare and the State's Health Plans |
| Available Health Plans |
| Managed Care Organization (MCO) Health Plans |
| Disease Management Program |
| Medicare and Prescription Drug Coverage |
| Notice of Creditable Coverage |
| SilverScript |
| For More Information |
| Retirees Health Insurance Premiums |
| 2013 Health Insurance Premiums for Medicare-Eligible Retirees |
| 2013 Health Insurance Premiums for Medicare-Eligible Retirees with SilverScript |
| Retiree Health Insurance Resources |
| Retiree 2013 Enrollment & Change Health Insurance Flyer |
| Medicare & You Centers for Medicare & Medicaid Services publication |
| 2013 Health Plans Side-by-Side Comparison |
| Medicare Part D Creditable Coverage Letter |
| SilverScript |
For general information about the State of Iowa's health insurance plans, go the DAS Health Insurance website.
Medicare
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Major parts of Medicare are:
- Part A (Hospital Insurance) helps covers your inpatient care in hospitals. Part A also helps cover skilled nursing facility, hospice, and home health care if you meet certain conditions. There is no cost for Medicare Part A as long as you are eligible for the Social Security benefit.
- Part B (Medical Insurance) helps cover medically-necessary services like doctors’ services and outpatient care. Part B also helps cover some preventive services. Most people will pay the standard monthly premium for Medicare Part B.*
- Part D (Prescription Drug Coverage) is an option to help cover the cost of prescription drugs.
*Higher-income beneficiaries will pay higher premiums for Part B and Part D coverage. Less than 5% of people with Medicare are affected, so most people will not pay a higher premium. Consult Social Security if you have questions regarding the amount you will pay.
The Centers for Medicare & Medicaid Services’ Medicare & You contains extensive information on Medicare.
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Medicare-Eligibility and SLIP Dollars
If you were a Sick Leave Insurance Program (SLIP) retiree and you turn 65 or become Medicare-eligible, your SLIP money will no longer be available to you. The Department of Administrative Services will send you a letter if:
- You are three months from your 65th birthday.
- Your spouse is three months from his/her 65th birthday.
- You are three months from exhausting your SLIP account.
The letter will remind you of your options for continuing State of Iowa group health insurance. If you receive Medicare due to SSA disability, you need to contact DAS at 515-281-6124, as you are no longer eligible for SLIP.
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Medicare Supplement Plan
If you were a SLIP retiree and you become Medicare-eligible, you may elect to drop the State of Iowa group coverage and purchase a private Medicare supplement plan. A Medicare supplement plan differs from the state group in that the benefits provided vary by supplement option. To learn more about Medicare supplement plans, review the information at the State of Iowa’s Senior Health Insurance Information Program’s (SHIIP) website.
If you drop State of Iowa health coverage, coverage for your spouse and dependents is also cancelled and there is no provision for rejoining the group at a later date.
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Medicare and the State’s Health Plans
You can continue your state-sponsored health coverage when you become eligible for Medicare. Benefits offered to Medicare-eligible retirees are the same as the benefit plan offered prior to becoming Medicare-eligible.
If you choose to continue in one of the state-sponsored health plans, you must notify Wellmark of your enrollment in both Parts A and B of Medicare.
Medicare becomes the primary payer on your claims and the state health plan is the secondary payer.
2013 Medicare-Eligible without SilverScript Monthly Health Insurance Premiums
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Health Plans Available to Medicare-Eligible Retirees
The following Wellmark health plans are available to Medicare-eligible retirees.
| Regular Health Plans | Coordinate with Medicare |
| Blue Access | Group N Plan |
| Blue Advantage | |
| Deductible 3 Plus | |
| Gold Preferred | |
| Iowa Select | |
| Program 3 Plus |
The same health plan provisions that govern active employees’ coverage also apply to Medicare-eligible retirees’ coverage.
Health Plans Comparison
The different health plans enable you to select a health plan that best meets your individual and family needs. To assist you in making a decision, a side-by-side comparison of the regular health plans is available for your review.
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Summary of Benefits and Coverage
The Affordable Care Act (ACA) requires Wellmark to provide you information about the health insurance coverage of the different plans in a standardized and consistent format. The Summary of Benefits and Coverage (SBC) has several key sections and features, including:
- Important questions and answers
- Coverage details for common medical events
- Covered and excluded services
- Two coverage examples with questions and answers to help you understand your share of costs.
Summary of Benefits and Coverage (SBC)
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Managed Care Organization (MCO) Health Plans
The state offers two managed care organization (MCO) plans.
- Blue Access
- Blue Advantage
Blue Access and Blue Advantage are managed care plans. As such, health care services are provided by a state-wide network of participating health care providers. Providers who participate in these plans are called Wellmark Health Plan Network providers.
Benefits for covered services are available only when received from Wellmark Health Plan Network providers.
It is your responsibility to ensure that providers you seek services from are part of the Wellmark Health Plan managed care network. Services received from non-participating providers will not be paid by Wellmark. Visit the Wellmark website to check participating providers in your area.
Services received from out-of-network providers in the following situations may be covered:
- Accidental Injuries
- Emergencies
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Medicare and Prescription Drug Coverage
If you are enrolled in one of the State of Iowa’s regular health care plans, it is not necessary for you to enroll in a Medicare Part D (Medicare Prescription Drug Coverage) plan. The state’s prescription drug coverage provisions apply.
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Notice of Creditable Coverage
The State of Iowa has determined that your prescription drug coverage with the state’s health care plans is as good as or better coverage than the standard Medicare prescription drug coverage (Part D). This means that your State of Iowa coverage is considered “creditable coverage” and that you will not pay extra if you later decide to enroll in Medicare prescription drug coverage (please review the Notice of Credible Coverage).
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SilverScript
If you are a Medicare-eligible member of one of the Wellmark plans offered by the State of Iowa group, you have the option of coordinating pharmacy benefits with one particular Part D plan called SilverScript Value (formerly SilverScript Basic). This coordination between Wellmark and SilverScript will result in a monthly premium savings to you. SilverScript is not available for members enrolled in Wellmark's Deductible 3 Plus.
The DAS SilverScript website has detailed information about the State of Iowa's prescription drug benefit SilverScript.
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Group N Plan
The Group N Plan is similar to the Medicare Supplement Plan N that you can purchase individually.
Group N Plan provides extensive coverage in supplementing your Medicare coverage. You have national coverage with any healthcare provider that accepts Medicare. The plan covers the Medicare Part A expenses not covered by Medicare. After meeting the Medicare Part B annual deductible, you pay up to $20 per office visit and $50 per emergency room visit (waived if admitted and if covered under Medicare Part A).
Detailed information about the Group N Plan is available at the Group N Plan for Medicare-Eligible Retirees website.
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For More Information
Contact Rachel Orris at 515-281-6124 if you have any questions or need additional information.
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Last updated 12/06/2012