Iowa Health and Wellness Plan Member Contributions
Iowa Health and Wellness Plan members who complete the Healthy Behaviors requirements will not be responsible for a monthly contribution. A contribution or premium is the amount of money members may have to pay each month to keep health coverage. During the first year of coverage there are no monthly contributions for any Iowa Health and Wellness Plan members. After that, some members may be responsible for a monthly contribution if they decide not to complete the Healthy Behaviors requirements.
To participate in the Healthy Behaviors Program and avoid paying a monthly contribution after the first year of coverage Iowa Health and Wellness Plan members must:
- Get a wellness exam (annual physical) from their health care provider or a dental exam from their dental provider; and
- Complete a health risk assessment (HRA).
What is the Monthly Contribution?
There are no charges for health services in a member's first year of enrollment (12 months). Starting in the second year of enrollment, although there are no copayments for health care services and prescriptions, depending on family income a small monthly contribution may be required. Some Iowa Wellness Plan members will contribute $5 per month and Iowa Marketplace Choice Plan members will contribute $10 per month. Iowa Wellness Plan members with individual earnings less than 50 percent of the Federal Poverty Level ($5,835 per year for an individual, or $7,865 for family of 2) will not have monthly contributions.
Frequently Asked Questions
Who will be asked to pay a monthly contribution?
Some Iowa Health and Wellness Plan members will be asked to pay a monthly contribution.
• Individuals with income 0-50 percent of the Federal Poverty Level: No contribution, per state legislation.
• Individuals with income 51-100 percent of the Federal Poverty Level: $5 monthly contribution, or $60 annually.
• Individuals with income 101-133 percent of the Federal Poverty Level: $10 monthly contribution, or $120 annually.
Individuals who are medically exempt, Alaskan Native or American Indian are also exempt from the monthly contributions.
How will members receive notice of the required payment?
Members will receive a monthly billing statement in the mail from Iowa Medicaid. The statement will be sent near the end of each month, for the next month’s coverage (March statement sent at the end of February). It’s important to make sure Iowa Medicaid has the most up-to-date address information for members so communication is sent to the correct address.
How can members make a payment?
Members may make a payment by check or by money order. Each statement will include a payment coupon. The member should return the payment coupon with the check or money order in the postage-paid, self-addressed envelope included with the statement.
Can members claim hardship?
Yes. A member can claim financial hardship, if one exists in the month. Hardship may only be claimed for one month at a time, and must be claimed during the month. It cannot be claimed retroactively, or after a bill is due. When a member claims hardship, no payments are ever due for the month that hardship was claimed.
Members may claim harship by checking the box on the payment coupon of the billing statement and returning it in the postage-paid, self-addressed envelope. Members may also claim hardship over the phone by calling Iowa Medicaid Member Services at 1-800-338-8366, or 515-256-4606 in the Des Moines area, 8 a.m. – 5 p.m., Monday- Friday.
Can a member pay more than one month at once?
Yes. A member can pay more than one month at once.
Do contributions stop if a member completes the Healthy Behaviors mid-year?
No. Members have 12 months to complete the Healthy Behavior activities which consist of completing a Wellness Exam and a Health Risk Assessment (HRA). A Wellness Exam includes an annual exam completed by their primary care provider or a dental exam completed by their dental provider. The member will only need to complete one of these each year of their Iowa Health and Wellness Plan enrollment. The HRA can be completed over the phone by calling Iowa Medicaid Member Services at 1-800-338-8366, 8:00am – 5:00pm, Monday – Friday. Members are given an additional 30 day grace period when contributions initially begin to complete these activities. If the member does not complete the Healthy Behaviors during their timeframe given, contributions will be owed. Completing the Healthy Behavior activities throughout the year will waive any possible contributions for the following year.
How long does the member have to complete the Healthy Behaviors to waive future contributions?
The member is given 12 months to complete Healthy Behaviors, and is given an additional 30 day grace period when contributions initially begin.
• Example: Initially enrolled January 2014. Contributions begin January 2015. Iniital 12 months January- December 2014, with 30 day grace period ending January 30, 2015.
The member states that they have completed both Healthy Behaviors, but still received a statement. Why did this happen?
It is possible that Iowa Medicaid does not have information on completed activities. Wellness exams are counted through claims submitted, so if an exam occurred close to the beginning of the contributions, Iowa Medicaid may not yet have the claim and official record of the exam. If this occurs, the member should call Iowa Medicaid Member Services.
Who should members call if they have questions about contributions?
Questions about contributions can be directed to Iowa Medicaid Member Services at 1-800-338-8366, or 515-256-4606 in the Des Moines area, 8 a.m. – 5 p.m., Monday- Friday.
Will members loose their Medicaid coverage if they do not pay the monthly contributions?
• Members with income 51-100 percent of the Federal Poverty Level: No loss of coverage, unpaid contributions form a debt to the state.
• Members with income 101-133 percent of the Federal Poverty Level: May be disenrolled for non-payment of contributions after 90 days. Unpaid contributions form a debt to the state. Members can re-enroll in coverage.