By Sonya Sellmeyer, Consumer Advocacy Officer for the Iowa Insurance Division
The COVID-19 Public Health Emergency allowed the Iowa Department of Health and Human Services to grant continual coverage for Medicaid and Children’s Health Insurance Program (CHIP), also known as Hawki, enrollees. Beginning April 1, 2023, Iowa Medicaid resumed reviewing member eligibility. The process is called renewal, or the unwind of continuous coverage that was required during the Public Health Emergency. Some Medicaid members have already received their renewal letters and responded to requests to verify contact information from Iowa Medicaid and/or from Iowa’s managed care organizations. During the renewal process, letters will be sent to different groups of members whose scheduled renewal date is coming up. This will continue through March 2024. If you have gotten a letter from Medicaid, check the letter for the current coverage status, and return any requested information.
If you no longer qualify for Medicaid/Hawki, there are healthcare options available:
If you are under 26 years of age, see about health insurance coverage under a parent’s policy.
Inquire with your employer or spouse’s employer about options for health insurance. Understand the type of policy offered, its benefits, and the premiums. You must request coverage from your employer within 60 days from the date you lose Medicaid eligibility.
If the employment coverage is not affordable, consider a Health Insurance Marketplace plan on Healthcare.gov. For those losing Medicaid eligibility, there will be a special enrollment period from March 31, 2023 to July 31, 2024. “Marketplace” plans may offer a subsidy in the form of a tax credit that lowers your monthly premium and cost-sharing reductions that will lower your deductible and copays. Ninety percent of all Iowans receive significant monthly subsidies and the average monthly premium in 2023 for Iowans is $105. Marketplace plans cover doctor visits, urgent care, hospital visits, and prescription drugs.
To apply for a Marketplace policy, visit Healthcare.gov as early as 60 days before your coverage ends, and pick the option regarding lost Medicaid or CHIP eligibility. After you apply, compare insurance plans before making a decision. Look at the network to ensure the plan has in-network coverage that includes your doctors. Also, review the prescription drug coverage to make sure your prescriptions are covered. You will have 60 days after submitting your application to enroll in a plan, and coverage will start the first day of the month after the plan is selected.
During this period of uncertainty, scammers will be lurking. If you are considering purchasing an ACA- compliant plan, check to ensure that the plan includes all of the ten essential health benefits and does not have annual or lifetime coverage maximums. Use a navigator or licensed insurance agent to assist. Beware of unsolicited phone calls and mailings that appear to be from Medicaid or Healthcare.gov, the official Marketplace website. Advertisements attempting to sell you health insurance using a politician's face are not legitimate healthcare plans. Don’t answer your phone to unknown numbers, or give out your personal information like bank account numbers, social security, Medicare numbers, etc. Consider the source, always go to the trusted website, and don’t click on links in emails or texts.
You may also consider other options such as health coverage through a health benefit plan sponsored by a non-profit agricultural organization or through short-term limited duration plans. The Iowa Insurance Division has authorized the following companies to sell short-term limited duration plans for up to 364 days. No other carriers are authorized to sell short-term limited duration plans.
Contact the Iowa Insurance Division at 877-955-1212 if you need assistance determining your healthcare needs.
End of Continuous Enrollment and Actions for Medicare, or Medicare-eligible, Persons
If you are on Medicare (or are Medicare eligible) your benefits may also change during the redetermination process that is currently underway. You may be removed from Medicaid, or your level of assistance may change. Depending on your situation you may have several actions to take including:
- Ensuring you have a prescription drug plan.
- Ensuring your prescription drug plan covers all your drugs.
- Finding additional coverage through a Medicare Supplement or Medicare Advantage Plan. If you are 65 or older, and lost your Medicare Supplement Open Enrollment opportunity because you continued your Medicaid benefits due to the Pandemic, you will have a guaranteed issue to purchase a Medicare supplement. This opportunity will end 63 days from the date of the change in your Medicaid benefits.
If Medicaid does make a change to your benefits, you can contact the Iowa Insurance Division’s SHIIP/SMP Program to find free Medicare counseling services near you. SHIIP/SMP can be reached at 1-800-351-4664 or online at shiip.iowa.gov.