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.