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.
Medicare
Medicare Eligibility and SLIP Dollars
Medicare Supplement Plan
Medicare and the State's Health Plans
Health Plans Available to Medicare-Eligible Retirees
Managed Care Organization (MCO) Health Plans
Medicare and Prescription Drug Coverage
Notice of Creditable Coverage
SilverScript
Wellmark Premium Savings
Cost of SilverScript
Enrollment in SilverScript
SilverScript Customer Service
For More Information
Retiree Health Insurance Resources
Retiree Health Insurance Flyer
Medicare Part D Creditable Coverage Letter
Wellmark Disease Management Program
Retirees Health Insurance Premiums
2008 Health Insurance Premiums for Medicare-Eligible Retirees
2008 Health Insurance Premiums for Medicare-Eligible Retirees with SilverScript
For general information about the State of Iowa's health insurance plans, go the DAS-HRE Health Insurance Web site.
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.
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 2008. However, your monthly premium will be higher if you are single (file an individual tax return) and your yearly income is more than $82,000, or if you are married (file a joint tax return) and your yearly income is more than $164,000.
For additional information on Medicare, the following link directs you to the Centers for Medicare & Medicaid Services’ 2008 edition of “Medicare & You.”
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Medicare Eligibility and SLIP Dollars
If you were a 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, or 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.
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 Medicare supplement plans, the following link directs you to the State of Iowa’s Senior Health Insurance Information Program’s (SHIIP) “Guide to Medicare Supplement Insurance” booklet.
SHIIP's Guide to Medicare Supplement Insurance
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.
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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.
For general information about the state’s health insurance plans, go to the DAS-HRE Health Insurance Web page.
If you choose to continue in one of the state-sponsored health plans, you must notify your insurance carrier (Wellmark or UnitedHealthcare) 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 then the total retiree premium since the state health plan is secondary. Following is a link to the 2008 Medicare-eligible retiree health rates.
2008 Health Insurance Premiums for Medicare-Eligible Retirees
Health Plans Available to Medicare-Eligible Retirees
You have the same health and dental plans available as a Medicare-eligible retiree as active employees. For 2008, Medicare-eligible retirees have the following health plans available.
Wellmark Blue Cross Blue Shield
Blue Access
Deductible 3 Plus
Blue Advantage
Iowa Select
Program 3 Plus
UnitedHealthCare
UnitedHealthcare Choice HMO
UnitedHealthcare Heritage Select
The same health plan provisions that govern active employees’ coverage also apply to Medicare-eligible retirees’ coverage.
For general information about the State of Iowa's health insurance plans, go the DAS-HRE Health Insurance Web site.
Managed Care Organization (MCO) Health Plans
Depending upon your location, you may have a Managed Care Organization (MCO) health plan option. The state offers four MCO plans in 2008. They are:
- Wellmark Blue Cross Blue Shield Blue Access
- Wellmark Blue Cross Blue Shield Blue Advantage
- UnitedHealthcare Choice HMO
- UnitedHealthcare Heritage Select
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. IMPORTANT: Services will not be paid by the carrier if you do not go to participating providers for all your health care needs.
2008 Managed Care (MCO) Service Area Map
2008 Managed Care (MCO) Service County Table
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 |
MCO * |
| 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 |
* Managed Care Organization (MCO) Plans - Blue Access, Blue Advantage, UnitedHealthcare Choice HMO and UnitedHealthcare Heritage Select
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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).
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 Basic. When you enroll in SilverScript, SilverScript becomes the primary plan for prescription drugs and the State of Iowa’s plan becomes secondary. Enrollment in SilverScript is voluntary.
SilverScript coordinates Medicare Part D coverage with four Wellmark plans. The Wellmark plans that coordinate coverage with SilverScript are:
- Blue Access
- Blue Advantage
- Iowa Select
- Program 3 Plus
SilverScript Basic is not available if you are enrolled in Wellmark’s Deductible 3 Plus, UnitedHealthcare’s Choice HMO, or UnitedHealthcare Heritage Select.
When you enroll in SilverScript you will not notice any difference in your prescription drug coverage. You will still pay your prescription copayments according to your plan, like you always have. You will have two ID cards – Wellmark and SilverScript. You will use this SilverScript identification card in addition to your Wellmark identification card at the pharmacy. You must show both of these identification cards at the pharmacy for claims to be filed correctly. Tell your pharmacist to file your claim first under the SilverScript card, and then under your State of Iowa plan card. Under the coordinated pharmacy benefits, SilverScript will pay your claims as primary and the State of Iowa Wellmark plan will pay as secondary. You need to make sure your pharmacy files your claims this way in order to receive the correct State of Iowa plan copayments.
The following link contains charts that shows the way the prescription drug coverage is coordinated through SilverScript Basic and the state's health plans.
Coordination of Prescription Drug Benefits
Wellmark Premium Savings
This coordination between Wellmark and SilverScript Basic results in a monthly premium savings to you. As a retiree, you can save from $75.68 up to $269.98 a month in Wellmark premiums (depending upon health plan and coverage level.) Following is a link to the 2008 Medicare-eligible retiree health rates.
2008 Health Insurance Premiums for Medicare-Eligible Retirees with SilverScript
2008 Wellmark Premium Savings with SilverScript
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Cost of SilverScript
The cost of SilverScript in 2008 is $26.60/month in Iowa per Medicare-eligible enrollee ($53.20 per Medicare-eligible couple.) The cost may be different in other states.
Enrollment in SilverScript
You may enroll in the coordinated Part D plan, SilverScript, by contacting SilverScript at 866-808-7475 when you first become Medicare eligible OR each year during the annual enrollment and change period.
SilverScript Customer Service
Once you are enrolled in SilverScript, you can can contact SilverScript's customer service area at 800-678-1853.
For More Information
Contact Rachel Orris at 515-281-6124 or e-mail Rachel Orris if you have any questions.
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