Health Insurance Premium Payment Program

Cost-effective means it’s cheaper for the Department to pay for a person’s private health insurance (including premiums, out-of-pocket costs, wrap-around services, and admin fees) than to pay for their care through Medicaid managed care.

To figure this out, the HIPP program adds up the total cost of the private insurance (premiums, deductibles, copays, and admin fees) and compares it to what Medicaid would pay an MCO for the same person (based on age, gender, and eligibility).

Cost sharing means the out-of-pocket costs (like copays and deductibles) that Medicaid pays because the health plan does not. 

Wrap-around benefits (or "wrap") are services private insurance doesn’t cover but Medicaid does—like case management, SCL services, adult diapers, transportation, or school-based services. Medicaid is usually the only one paying for these.

This list is not inclusive.

• Verification of the cost of all possible insurance plan options (e.g. single, employee/spouse, employee/children, family) or for an individual policy, the cost breakdown per individual. **
• Complete summary of benefits and coverage for the health and prescription plan. This shows what your prescription and health insurance plan covers, including deductibles, copayments, coinsurance, and out-of-pocket costs.* **
• Pay stub containing a health insurance premium deduction or proof of payment (e.g., bank/credit card statement, endorsed check, payment receipt).
• Copy of the front and back of the health insurance and prescription cards.
• Employer issued COBRA continuation coverage letter.

* You may need to access your employer's website or contact your human resources department to get this information.

** You may need to contact your insurance agent or insurance company to get this information.

This list is not inclusive. The HIPP program does not provide premium assistance for:

• Insurance for someone who does not live in your home.
• School plans based on enrollment or attendance as a student.
• An insurance plan that pays income to the policyholder or pays only limited amounts for services.
• Plans that are limited to a temporary period of time.
• Plans that have an absent parent as the policyholder, or when the policyholder is not part of your Medicaid household.
• An insurance premium that is used to reduce the Medically Needy spend down amount for Medicaid or used as a deduction in computing the client participation
• Anyone covered under Medicaid Kids with Special Needs (MKSN), Family Planning Program (FPP), or Health Insurance Plan Iowa (HIPIOWA).
• The insurance plan is a high-deductible health plan, pursuant to the guidelines of the Internal Revenue Service (IRS).
• The insurance plan is a subsidized insurance plan purchased through a government-run health insurance exchange.
• Someone who has Medicare.
• Someone who is covered under the insurance plan and is not Medicaid-eligible on the date the decision regarding eligibility for the HIPP program is made.
• The health plan pays secondary to another plan.

Iowa HHS is updating the tool used to determine whether HIPP is cost-effective for members. This updated tool will help Iowa HHS keep it accurate over time. 

All active HIPP members before October 1, 2026, are being grandfathered into the program and will remain covered unless their Medicaid eligibility or private insurance participation changes, or they do not return a review.

No action is required. You will remain enrolled under the grandfathering policy. However, it’s important to keep your information up to date with HHS.

The AIDS/HIV HIPP program helps persons living with AIDS/HIV-related illness by paying their health insurance premiums when they become too ill to work.

To qualify for services under the AIDS/HIV HIPP program, the person must:

• Be ineligible for Medicaid
• Be a resident of Iowa
• Provide a doctor's certification that the person's ability to work is impaired due to AIDS or HIV-related illness.
• Be the policyholder of the health insurance plan or be a dependent on their spouse's health plan.
• Have "liquid" assets (cash, stocks, bank accounts, etc.) of less than $10,000.
• Meet the income limits.

Gross income cannot exceed 300% of the federal poverty level for a household of the same size. Effective April 1, 2015, the monthly limits are:

• 1 Person Household - $2,943.00
• 2 Person Household - $3,983.00

An application is included in the program brochure called "The Iowa AIDS/HIV Health Insurance Premium Payment Program (Comm 99)". You may obtain a brochure by calling or visiting your local county Department of Human Services Office or by calling the toll-free HIPP customer service number at 1-888-346-9562.

The AIDS/HIV program is administered by the staff of the HIPP Program Unit in Des Moines. The HIPP program is part of the Iowa Medicaid.

You can call the toll-free HIPP customer service number at 1-888-346-9562. All communications regarding this program will be held in the strictest confidence.