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.
For general information about the state of Iowa's health insurance plans, go the DAS Health Insurance Web site.
Retirees Health Insurance Premiums
2009 Health Insurance Premiums for Medicare-Eligible Retirees
2009 Health Insurance Premiums for Medicare-Eligible Retirees with SilverScript
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).
Two major parts of Medicare are:
- Medicare 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. You don't pay a monthly premium for Part A coverage.
- Medicare Part B (Medical Insurance) helps cover medically-necessary services like doctors’ services and outpatient care. Part B also helps cover some preventive services. You pay the Part B premium each month. Most people will pay the standard premium amount, which is $96.40 in 2009. However, your monthly premium will be higher if you meet the following conditions:
- You are single (file an individual tax return), and your yearly modified adjusted gross income is more than $85,000 in 2009.
- You are married (file a joint tax return), and your yearly modified adjusted gross income is more than $170,000 in 2009.
The Centers for Medicare & Medicaid Services’ 2009 edition of Medicare & You contains extensive information on Medicare.
 |
return to top |
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 within three months of your 65th birthday
- Your spouse will be turning 65
- If you have less than $3,000 in 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 your former department's Personnel Assistant, as you are no longer eligible for SLIP.
|
return to top |
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 state of Iowa’s Senior Health Insurance Information Program’s (SHIIP) SHIIP's Guide to Medicare Supplement Insurance booklet.
If you drop state of Iowa health coverage, coverage for your spouse and dependent is also cancelled and there is no provision for rejoining the group at a later date.
|
return to top |
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. The premiums for the state health plans are lower than the total retiree premium since the state health plan is secondary. Following is a link to the 2009 Medicare-eligible retiree health rates.
2009 Health Insurance Premiums for Medicare-Eligible Retirees
|
return to top |
Health Plans Available to Medicare-Eligible Retirees
You have the same health and dental plans available as a Medicare-eligible retiree as an active employee. The following Wellmark Blue Cross Blue Shield health plans are available in 2009.
- Blue Access
- Blue Advantage
- Deductible 3 Plus
- 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 different health plans is available for your review.
The chart compares coverage of each plan in areas such as:
| Deductible | The amount you pay each year toward your initial covered expenses before the plan begins to pay. |
| Coinsurance | The percentage of the covered expenses you must pay. |
| Copayment | The amount you must pay at the time a service is rendered. |
|
return to top |
Managed Care Organization (MCO) Health Plans
The state offers two Wellmark Blue Cross Blue Shield MCO plans in 2009. They are:
- Blue Access
- Blue Advantage
The following map and table links indicate the counties that have adequate participating providers to offer services as noted. Please check the provider directories for any plans that interest you to ensure that there are participating doctors, specialists, labs, hospitals, clinics, etc. in your area.
2009 Managed Care (MCO) Service Area Map
2009 Managed Care (MCO) Service County Table
IMPORTANT: Services will not be paid by Wellmark if you do not go to participating providers for all your health care needs.
|
return to top |
Disease Management Program
For individuals with certain chronic diseases, disease management is a program designed to help individuals take a more active role in managing their condition. A disease management program provides individualized care plans for employees or their family members with treatable chronic diseases to improve their health outcomes. The program provides personalized contact with a nurse, educational materials, and other services to educate individuals while supporting their physician’s plan of care. A disease management program is offered to state of Iowa employees and retirees enrolled in a Wellmark Blue Cross Blue Shield health plan. Participation in the program is voluntary.
Disease Management Frequently Asked Questions
|
return to top |
Medicare and Prescription Drug Coverage
If you are enrolled in one of the state of Iowa’s 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. Following is a summary of the state’s prescription drug benefit.
| Prescription Drugs | Deductible 3 Plus |
Program 3 Plus |
Iowa Select |
Blue Access Blue Advantage |
| Retail - Preferred generic - Preferred brand name - Non-preferred brand or generic |
20% after deductible |
$5 copay $15 copay $30 copay |
$5 copay $15 copay $30 copay |
$5 copay $15 copay $30 or 25% (whichever is higher) |
| Mail Order - Preferred generic - Preferred brand name - Non-preferred brand or generic |
Not Available |
$10 copay $30 copay $60 copay |
$10 copay $30 copay $60 copay |
$10 copay $30 copay $60 copay |
| Out-of-Pocket Maximum - Single - Family |
No separate out-of-pocket |
$250 $500 |
$250 $500 |
No separate out-of-pocket |
Self-Administered Specialty Drugs
Specialty drugs are high-cost injectable, infused, oral or inhaled drugs for the ongoing treatment of a chronic condition. These drugs generally require close supervision and monitoring of the patient’s drug therapy.
Self-administered specialty drugs are covered under the prescription drug plan instead of the health plan. This benefit feature applies to all Wellmark plans offered except Deductible 3 Plus.Depending on the specialty drug, your cost share will be either the copay of the preferred brand name drug (tier 2) or the non-preferred brand name drug (tier 3). The following table is the prescription drug copays or coinsurance amounts for the Wellmark plans affected by this benefit design change. The majority of self-administered specialty drugs are on the non-preferred brand name drug (tier 3).
Self-Administered Specialty Drugs |
Tier 2 Preferred Brand Name Drug |
Tier 3 Non-Preferred Brand Name Drug |
| Blue Access | $15 copay |
$30 copay* |
| Blue Advantage | $15 copay |
$30 copay* |
| Iowa Select | $15 copay if you have not reached your maximum out-of-pocket | $30 copay if you have not reached your maximum out-of-pocket |
| Program 3 Plus | $15 copay if you have not reached your maximum out-of-pocket | $30 copay if you have not reached your maximum out-of-pocket |
* For self-administered specialty drugs, the copay is $30. The coinsurance of 25% does not apply.
Additional information on specialty drugs is available at the DAS Wellness Prescription Drug site.
Vaccines at the Pharmacy
As a Medicare-eligible retiree, you also have the convenience of going to a pharmacy to receive certain vaccines as part of your pharmacy benefits. The DAS Wellness Prescription Drug site contains information on vaccines at the pharmacy.
|
return to top |
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).
|
return to top |
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 Web site has detailed information about the state of Iowa's prescription drug benefit SilverScript.
|
return to top |
For More Information
Contact Rachel Orris at 515-281-6124 if you have any questions or need additional information.
|
return to top |
Site updated 12/26/2008