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As an Iowa Medicaid member, we want to help you feel comfortable finding a managed care plan that meets your needs. We'll help you:
- Search for plans that cover your preferred doctors and providers
- Compare covered benefits and services, extra services, and costs
- Compare plans by the quality of care that matters most to your family
- View experience ratings from current health plan members
Here are some steps and guidelines for comparing managed care plans.
Back to topStep 1: Understand the health and dental plans available in Iowa.
- Health, vision, and prescription coverage is available statewide through either of the following health plans: Wellpoint, Iowa Total Care, or Moline Healthcare.
- Dental coverage is available statewide through either Delta Dental or MCNA Dental.
- You can only choose one health plan and one dental plan to get your benefits and services.
Step 2: Verify doctors covered by each health plan.
- One of the biggest differences between health plans is which doctors they work with.
- Ask your doctor which Iowa Medicaid health plan they work with, or check with each health plan to make sure your doctor is included.
Step 3: Review your health plan covered benefits and services by coverage group.
- Your coverage group is chosen when you are approved for Medicaid. It decides what benefits and services you can get.
- If you are ever unsure of your coverage group or have specific questions related to your health
coverage you can always contact Medicaid Member Services for assistance. - Detailed benefit information by coverage group is available at hhs.iowa.gov/Iahealthlink
or https://hhs.iowa.gov/programs/welcome-iowa-medicaid/iowa-health-link/hawki
Iowa Medicaid Benefits & Services by Coverage Group
| Basic Benefits & Services | Medicaid | IHAWP* | Hawki |
|---|---|---|---|
Primary Care Provider (PCP) Office Visits/Telehealth | Covered; limitations or prior authorizations may apply to certain services. | Covered; limitations or prior authorizations may apply to certain services. | Covered; limitations or prior authorizations may apply to certain services. |
Specialist Visits Office Visits/Telehealth | Covered; PCP referral may be required; limitations or prior authorizations may apply to certain services. | Covered; PCP referral may be required; limitations or prior authorizations may apply to certain services. | Covered; PCP referral may be required; limitations or prior authorizations may apply to certain services. |
Pharmacy/Medication Covered Prescription | Covered; limitations or prior authorizations may apply to certain drugs; 90-day supply is available for drugs on the Preferred Drug List (PDL); 31-day supply for all other prescriptions. Refills are only available once member has used 85% of the supply. | Covered; limitations or prior authorizations may apply to certain drugs; 90-day supply is available for drugs on the Preferred Drug List (PDL); 31-day supply for all other prescriptions. Refills are only available once member has used 85% of the supply. | Covered; limitations or prior authorizations may apply to certain drugs; 90-day supply is available for drugs on the Preferred Drug List (PDL); 31-day supply for all other prescriptions. Refills are only available once member has used 85% of the supply. |
Emergency Care Hospital Emergency Room (ER) Visits, Ambulance, Urgent Care Centers | Covered | Covered | Covered; urgent care centers may require prior authorization. |
Hospital Services Inpatient/outpatient Services | Covered; limitations may apply to certain services. Preapproval of inpatient admissions is required for non-emergent admissions. | Covered; limitations may apply to certain services. Exception: Bariatric surgery for morbid obesity is not covered. Preapproval of inpatient admissions is required for non-emergent admissions. | Covered; limitations may apply to certain services. Preapproval of inpatient admissions is required for non-emergent admissions |
Vision Eye Exams/Glasses | One routine vision exam per calendar year. Glasses are covered; limitations apply. | One routine vision exam per calendar year. Glasses for ages 19-20 are covered; limitations apply. | One routine vision exam per calendar year. Glasses are covered; limitations apply. |
Dental Preventative Care/ Dental Work | Routine dental services are covered by your dental plan. | Routine dental services are covered by your dental plan. | Routine dental services are covered by your dental plan. |
Long Term Services and Supports (LTSS) Waivers/Medical Facilities** | Covered; limitations or prior authorizations may apply to certain services; Waiver slots are limited, most waiver slots have a waitlist. | Not Covered; Exception: Some limited Skilled Nursing Facility (SNF) services are available. | Not Covered; Exception: Some limited Skilled Nursing Facility (SNF) services are available. |
*IHAWP members with a medically except status will receive state plan benefits, as listed under "traditional medicaid".
**Iowa’s waiver programs give extra help and services to people who qualify so they can stay in their home or community instead of going to a medical facility.
Back to topStep 4: Compare health plan extra services (e.g. Value Added Services
- Extra services will differ between Wellpoint, Iowa Total Care, or Molina Healthcare.
- Detailed Value Added Services information is available on each health plan's website.
Step 5: Review your health plan costs
- Costs are currently the same between all health plans; however costs will differ based on your coverage group eligibility, family income, and/or services provided.
- If there is a copayment, you will pay it to the provider.
Iowa Medicaid Costs by Coverage Group
| Cost Sharing | Medicaid | IHAWP | Hawki |
|---|---|---|---|
| Monthly premiums | No premium. | No monthly premium during first year of eligibility. To avoid paying a monthly premium after the first year, members must complete a Health Risk Assessment (HRA) to include either a wellness exam or dental exam. | Members may have a monthly premium based on family income. No family pays more than $40 a month. Some families pay nothing at all. |
| Office visit copay(s) | $1 to $3 copay based on types of services; $0 copay for any of the
| $0 copay | $0 copay |
| Covered prescription & nonprescription drug copay(s) | $1 copay | $0 copay | $0 copay |
| ER visit copay(s) | $0 copay; Non-emergency visits are subject to a $3 copay per visit | $0 copay; Non-emergency visits are subject to a $8 copay per visit | $0 copay; Non-emergency visits are subject to a $25 copay per visit if the family pays a premium for the Hawki program |
| Copayments for persons receiving long-term care/institutional | Based on family income level | Not applicable | Not applicable |
| Estate recovery | Estate recovery applies to Medicaid recipients who:
| Estate recovery applies to Medicaid recipients who:
| Estate recovery does not apply to Hawki members. |
Dental Plans
Like your healthcare plans, dental plans also offer an array of services based on your plan and plan provider. Learn how to choose your dental plan provider and compare costs.
Back to topNext Steps
Beyond this information, it's best to also compare performance and customer ratings and reviews for each plan. This will help you understand what your experience might be like as a member of the plan.
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