The following information explains how the State of Iowa health insurance interacts with Medicare.
Resources
- 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.
- Medicare and You is a great source of information about all aspects of Medicare.
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 hospital 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.
When you retire, and move from being an active employee to a retired employee staying on the State of Iowa's retiree insurance, you or covered family members 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.
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. 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.
Review the Coordination of State Health Plans and Medicare for more information.
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 Medicare-eligible covered family members.
Review the Coordination of State Health Plans and Medicare for more information.
Disability
Active Employee or Dependent, Spouse/Domestic Partner Medicare-Eligible Due to Disability
If you, a covered family member enrolled under your active employee State of Iowa health plan, become eligible for Medicare due to a disability, the State's health plan will continue to be the primary insurance.
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 contact the DAS Retiree Unit at 866-895-2464 or send an email to stateretirees@iowa.gov.
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 Human Resources Associate 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 open enrollment 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. If the State of Iowa is paying any portion of your health insurance premiums either through the Sick Leave Insurance Program (SLIP), please contact DAS-HRE at 866-895-2464 to inform them of your Medicare enrollment.
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.