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State of Iowa Health Insurance & Medicare

This following information explains how the State of Iowa health insurance interacts with Medicare.

Resource

Senior Health Insurance Information Program (SHIIP)
SHIIP is 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

The part of Medicare that helps pay for inpatient hospital care, some inpatient care in a skilled nursing facility, home health care, and hospice care.

Medicare Part B

The part of Medicare that helps pay for medically necessary physicians' services, outpatient hopital services, and a number of other medical services and supplies not covered by Medicare Part A, as well as some home health services. 

Medicare Part D

The part of Medicare that helps pay for prescription drug coverage. Medicare Part D plans are offered by private insurance companies.

The Medicare and You is a great source of information about all aspects of Medicare. 

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.

 

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.

Contract Holder 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

 

Contract Holder is a Retiree:

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


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.  

Active Employee Age 65 or Older Preparing to Retire

Contact your local Social Security office 3 months prior to your retirement date to determine your Medicare eligibility and to enroll in Medicare Part A and B.  Advise the representative that you have been working past age 65 and that your Medicare Part A and 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 Group MedicareBlue Rx Iowa, 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 Group MedicareBlue Rx Iowa.

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.


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.  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 Group MedicareBlue Rx Iowa, 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 Group MedicareBlue Rx Iowa. 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 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) program, please contact DAS-HRE at 515-281-6124 to inform them of your Medicare enrollment.


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 Group MedicareBlue Rx Iowa, 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 Group MedicareBlue Rx Iowa, 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 Group MedicareBlue Rx Iowa. 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.