About the Health Plan

Coordinated Care & More Personal Attention

Iowa Health Advantage is a Health Maintenance Organization (HMO) contracted with Medicare. Iowa Health Advantage offers an Institutional Special Needs Plan specially designed for eligible Medicare beneficiaries living in one of our participating long-term care nursing homes. As a Member of Iowa Health Advantage, you receive not only the standard benefits offered by original Medicare, but the added attention and care that are so important to your health and well-being.

Service Area

Iowa Health Advantage focuses on Members who meet institutional level of care criteria and live in a Iowa Health Advantage participating nursing homes located in the following Iowa counties:

  • Adams
  • Appanoose
  • Benton
  • Black Hawk
  • Boone
  • Butler
  • Calhoun
  • Carroll
  • Cedar
  • Cherokee
  • Clarke
  • Decatur
  • Dubuque
  • Guthrie
  • Hamilton
  • Hardin
  • Henry
  • Jasper
  • Johnson
  • Kossuth
  • Linn
  • Louisa
  • Lucas
  • Mahaska
  • Marion
  • Marshall
  • Monroe
  • Plymouth
  • Pocahontas
  • Polk
  • Poweshiek
  • Sac
  • Story
  • Union
  • Wapello
  • Wayne
  • Woodbury
  • Worth

Iowa Health Advantage covers all medically-necessary and preventive services covered under Medicare Part A and Part B, and prescription drug coverage under Part D.

Plus, Iowa Health Advantage includes extra benefits including vision, routine foot care, preventive care, in-home/out-of-home support services. You pay nothing for these extra benefits! This is a brief list of benefits we cover and what you pay. It does not list every medical service or item covered or every limitation or exclusion. For a complete list of covered medical services or items, you may call Iowa Health Advantage Member Services at 1-866-327-0523, TTY 1-833-312-0046 and request us to mail the Iowa Health Advantage [H6765-001] Evidence of Coverage to you.

Membership Advantages

    • Part D prescription drug coverage.
    • Vision, hearing, routine foot care, and preventive services and screenings.
    • Coordinated care and more personal attention.
    • Dedicated nurse practitioner as your trusted partner to manage your care and collaborate with your doctors, your family, and the nursing home staff.
    • Regular visits from your nurse practitioner to your residing nursing home to help avoid unnecessary and often unwanted trips to the hospital.
    • Your nurse practitioner can complete tests and treatments in the nursing home that are normally done in the hospital.
    • One point of contact for communication with you, your family, your doctors and nursing home staff.

Benefit Highlights 2023

How much is the monthly premium?

    • $39.90 Iowa Health Advantage [H6765-001] monthly plan premium.
    • Note: You must continue to pay your Medicare Part B premium (unless your Medicare Part B premium is paid for you by State Medicaid or another third party).

How much is the Parts A and B deductible?

    • $226 Iowa Health Advantage [H6765-001] per year for covered Parts A and B medical services and items you receive from in-network providers services.

How much is the Part D deductible?

    • $505 Iowa Health Advantage [H6765-001] deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?

    • Yes. Iowa Health Advantage (HMO I-SNP) protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.

Your yearly out-of-pocket limit(s):

    • $8,300 Iowa Health Advantage [H6765-001] annual out-of-pocket limit for covered Parts A & B medical services and items you receive from in-network providers.
    • If you reach the limit on out-of-pocket costs, you keep getting covered Parts A & B medical services and items and we will pay the full cost for the rest of the year.
    • Please note that you will still need to pay your monthly Medicare Part B premium (unless your Medicare Part B premium is paid for you by State Medicaid or another third party), your monthly Iowa Health Advantage (HMO I-SNP) premium, Part D prescription drug deductibles and Part D prescription drug cost-sharing.

Is there a limit on how much the plan will pay?

    • Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
Last Updated on February 15, 2023

Want more information about Iowa Health Advantage?

Call us at 1-866-327-0523; TTY 1-833-312-0046.
Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m., or fill out this contact request form to have us call you.

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