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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 Policyholder.  If the Policyholder 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.

Policyholder is an Active Employee:

If you are: And your age is: Which plan pays first for you?
Employee Any age State of Iowa plan
Spouse/Domestic Partner Any age State of Iowa plan

Policyholder is a Retiree:

If you are: And your age is: Which plan pays first for you?
State Retiree Under age 65 State of Iowa plan
Spouse/Domestic Partner Under age 65 State of Iowa plan
State Retiree Over age 65 Medicare
Spouse/Domestic Partner Over age 65 Medicare

 

When the contract holder retires, and moves from being an active employee to a retiree 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.


The Department of Administrative Services – Human Resources Enterprise is providing this information about the State of Iowa’s benefits. The information on this web page is subject to change. Nothing herein shall be construed as a guarantee of benefits. This webpage is not a complete description of the State of Iowa’s benefit plans. Nothing on this web page supersedes or changes any of the terms and conditions of any plan documents, insurance policies, or other legal agreements. If the wording in this web page contradicts any plan documents, laws, regulations, administrative rules, insurance policies, or other legal agreements, the wording in the official documents and agreements will govern.

Created 12/26//2019