Medicare Parts A and B pay for many, but not all, health care services and supplies. A Medicare Supplement Insurance policy helps pay some of the health care costs that Parts A and B don’t cover, like copayments, coinsurance and deductibles.
The State offers both Group Program F and Group Program N to Medicare-eligible retirees and their Medicare-eligible dependents. The designs of Group Program F and Group Program N are identical to the Medicare Supplement Plan F and N that you can purchase individually. Group Program F and Group Program N provide extensive coverage in supplementing your Medicare coverage. They have national coverage with any healthcare provider that accepts Medicare.
You are eligible to enroll in Group Program F and Group Program N if you are a Medicare-eligible State of Iowa retiree or a Medicare-eligible surviving spouse of a retiree. If you currently have family coverage and you enroll in Group Program F and Group Program N, your dependents must also enroll in Group Program F or Group Program N. If your dependents are not eligible for Medicare, they cannot enroll in Group Program F or Group Program N and they would be dropped from your coverage. Covered dependents are not allowed to stay on the regular State of Iowa insurance plans if you move to Group Program F or Group Program N. If your spouse or dependent is eligible for Medicare, but you are not, they cannot enroll in Group Program F or Group Program N until you, the retiree, are also eligible for Medicare and enroll in Group Program F or Group Program N.
This chart shows basic information about the different benefits Group Program F and Group Program N policies cover. If a percentage appears, the program covers that percentage of the benefit for eligible Medicare expenses. YOU must pay the rest.
|Benefits||F Pays||N Pays|
|Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)||100%||100%|
|Medicare Part B coinsurance or copayment||100%||100%*|
|Blood (first 3 pints)||100%||100%|
|Part A hospice care coinsurance or copayment||100%||100%|
|Skilled nursing facility care coinsurance||100%||100%|
|Part A deductible||100%||100%|
|Part B deductible||100%||0%|
|Part B excess charges||100%||0%|
|Foreign travel emergency (up to plan limits)||80%||80%|
*Group Program N pays 100 percent of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits not resulting in an inpatient admission.
Group Plan F and Group Plan N only cover Medicare-eligible expenses that are not paid by Medicare. As long as Medicare covers the service, it will be covered by Group Program F or Group Program N. Group Program F and Group Program N offer some additional coverage for travel outside the country that Medicare does not cover. You should read the Medicare and You book you received from Medicare and check with Medicare before scheduling services to be sure they will be paid.
- Lower monthly premiums than the traditional State of Iowa plans.
- Benefits that are more in line with the benefits and services that Medicare covers.
- No network restrictions, you can see any provider who accepts Medicare.
- Ability to move back to the regular State of Iowa plans (Program 3 Plus, Blue Access, etc.) during the next enrollment and change period.
- Enroll midyear if you need to wait for everyone on your plan to become eligible for Medicare.
- Includes a foreign travel benefit.
If both you and your spouse are Medicare-eligible, you and your spouse can:
- Both enroll in Group Program F, or
- Both enroll in Group Program N, or
- One enrolls in Group Program F and the other enrolls in Group Program N.
Complete two applications:
- Wellmark's State of Iowa Group Retiree Application (Indicate if you want to enroll in Group Program F or Group Program N.)
- Group MedicareBlue Rx PDP Application (Indicate if you want to enroll in Basic or Plus. Complete a new Group MedicareBlue Rx Application even if you are already enrolled in Group MedicareBlue Rx).
Your spouse will also need to complete both the State of Iowa Employer Group Retiree Program N and F Application and the Group MedicareBlue Rx PDP application.
Coupled with the Group Program F and Group Program N programs is a Group MedicareBlue Rx plan. You have the option of two Group MedicareBlue Rx plans:
- Group MedicareBlue Rx (Basic)
- Group MedicareBlue Rx (Plus)
There are two main differences between the Group MedicareBlue Rx Basic and the Group MedicareBlue Rx Plus plans:
- The copayments (amounts you pay) are different.
- Another significant difference is the amount of coverage you have while in the gap or “donut hole.”
- Group MedicareBlue Rx (Basic): In the current Basic plan, you have coverage for generics only, in the “donut hole.” Select brand name drugs are discounted, according to federal laws regulating these plans, but you will still pay about 50 percent of the cost of brand name drugs, while you are in the “donut hole.”
- Group MedicareBlue Rx (Plus): In the current Plus plan, you will pay the same copays as in the initial coverage period and in the coverage gap (“donut hole”).
If both you and your spouse enroll in the Group Plan F or Group Plan N, you and your spouse can:
- Both enroll in Group MedicareBlue Rx Basic, or
- Both enroll in Group MedicareBlue Rx Plus, or
- One enrolls in Group MedicareBlue Rx Basic and the other enrolls in Group MedicareBlue Rx Plus.
The Group Program F and the Group Program N Plan and the Group MedicareBlue Rx plan is a health insurance package. You cannot elect to just take the Group Plan F or the Group Plan N and not elect a Group MedicareBlue Rx plan.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
Social Security Administration
Your State Medicaid Office
Contact the Department of Administrative Services, Human Resources Enterprise at 866.895.2464 or email email@example.com if you have any questions or need additional information.