Frequently Asked Question



IMPORTANT UPDATE--TEMPORARY SUSPENSION OF MCO CHOICE

AmeriHealth Caritas Iowa, Inc. is withdrawing from the IA Health Link managed care program effective November 30, 2017. AmeriHealth Caritas members have been assigned to UnitedHealthcare. The department has put in place a temporary suspension of Managed Care Organization (MCO) choice.
 
Previously the Department notified members they would be able to choose Amerigroup Iowa. Due to concerns with capacity, Amerigroup Iowa is not accepting any additional members at this time. This also includes all new IA Health Link members. In the future members will be able to choose from multiple MCOs. Members will be notified when that choice is available. 
 
AmeriHealth Caritas’ members will transition to UnitedHealthcare effective December 1, 2017. Learn more by reading the sample member letter, the Press Release and the FAQs below.   
 

FAQ for Members

FAQ for Providers

Updated information will be posted as it is available. Please check back regularly.

What is the Iowa Health and Wellness Plan?

The Iowa Health and Wellness Plan program provides comprehensive health coverage at low or no cost to Iowans between the ages of 19 and 64. The Iowa Health and Wellness Plan refers to one plan that includes two separate eligibility groups. All Iowa Health and Wellness Plan members are covered for the same types of health benefits. Eligibility is based on household income.
 

How do I start the application process?

There are many ways to get started. Pick the one that's most convenient for you.
Imaging Center 4
P.O. Box 2027
Cedar Rapids, IA 52406
 

What will you ask me on the application?

You will need to provide your Social Security number, proof of income, general health information, and current health coverage information.
 

What happens after I complete the application?

After you complete and submit the application, you will receive a letter from the Department of Human Services stating whether or not you have been approved for health coverage through Iowa Medicaid. If approved, you will receive information about your health coverage options. The information you provide in your application will help make sure you get all of the options available to you. It will also determine if you are eligible for financial help.
 

Can anyone sign up for these health plans?

To be eligible, you must be able to answer yes to these questions:
  • Are you between the ages of 19 and 34?
  • Is your income at or below 133 percent of the Federal Poverty Level (FPL)?
    • Approximately $15,521 for an individual
    • Approximately $20,921 for a family of two (or higher depending on family size)
  • Are you a resident of Iowa?
  • Are you a U.S. citizen?

What will it cost me to be in the Iowa Health and Wellness Plan program?

All Iowa Health and Wellness Plan members can receive free* or low cost healthcare if they choose to take specific steps to protect their health and complete what are known as Healthy Behaviors. To participate in the Healthy Behaviors program and avoid paying a monthly contribution after the first year of coverage, each year Iowa Health and Wellness Plan members must get a wellness exam or get a dental exam, and they must complete a Health Risk Assessment.
 
Members who do not complete their Healthy Behaviors every year may be required to pay a small monthly contribution of either $5 or $10 depending on their family income.
 
Members who do not complete their Healthy Behaviors and do not pay their monthly bill after 90 days, depending on their income, may be disenrolled from the Iowa Health and Wellness Plan.
 
* There are very few, or no, out-of-pocket costs for the first year and very few costs after that. Depending on your family income, a small monthly premium might be required. There is an $8 co-pay for using the emergency room for non-emergency services.
 

What about the wellness exam or dental exam? Why visit a doctor or dentist if I am not sick?

An annual wellness exam or "physical" refers to a medical exam you receive from a health care provider that is aimed at preventing health problems before they occur. An annual dental wellness exam is a checkup from your dentist which aims to prevent dental problems before they occur. In the physical exam, the health care provider will do things like check your pulse and blood pressure, listen to your lungs with a stethoscope, recommend preventive screenings or take a blood sample to check your colesterol. This is different from the type of exam you might get when you visit a health care provider because you are sick or hurt and have specific health problems that need to be addressed.
 
A routine physical exam keeps your provider updated about your health so you can get the care you need and gives you a chance to talk to your health care provider about any health concerns. Even if you do not feel sick, you should get a physical exam from your health care provider every year.
 
In a dental exam, your dentist will go over your dental health. You may receive a cleaning or basic x-rays. It's important to maintain a healthy mouth. It's a key part of overall health. Remember, under the Iowa Health and Wellness Plan, you will not be charged for check-ups and preventive screenings.
 

Where can I learn more about Healthy Behaviors?

You can learn more about Healthy Behaviors on the Healthy Behaviors webpage at: http://dhs.iowa.gov/IHAWP/healthy-behaviors.
 

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 I receive notice of the monthly contribution?

Iowa Medicaid will send you a monthly billing statement. The statement will be sent near the end of each month, for the next month's coverage. Please make sure that Iowa Medicaid has your most up-to-date address information so that mail is sent to the correct address.
 

How can I make a payment?

You can make a payment by check or money order. Each statement will include a payment coupon and postage-paid envelope. When returning the payment, please make sure to include the payment and payment coupon in the postage-paid envolpe.  
 

Can I pay more than one month at a time?

Yes. You can pay more than one month at a time.
 

Will I lose my Medicaid coverage if I do not pay the monthly contribution?

  • 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 after the debt has been paid.

I am in the Iowa Health and Wellness Plan and am not able to pay my monthly contribution, what can I do so that I do not lose coverage?

If a member is unable to pay their contribution, they may check the hardship box on their monthly statement and return the payment coupon OR call the Iowa Medicaid Enterprise (IME) Member Services Unit at 1-800-338-8366 (M-F, 8-5).
 
IMPORTANT: Claiming financial hardship will apply to that current month's amount due only. Members will still be responsible for amounts due from past months. Members will also be responsible for amounts due in future months unless they claim hardship during those months. Any payment that is more than 90 days past due will be subject to recovery and, depending on their income, may be disenrolled.
 

Do my contributions stop if I complete my healthy behaviors mid-year?

No. Members have 12 months to complete their Healthy Behaviors. Members are given an additional 30 day grace period when their contributions intitially begin to complete their healthy behaviors. If the member completes their Healthy Behaviors during the 30 day grace period, their contributions for the year will be waived. If the member does not complete their Healthy Behaviors during the 30 day grace period, they will have monthly contributions. Completing Healthy Behaviors throughout the year will waive any possible contributions for the following year. 
 

How long do I have to complete the Healthy Behaviors to waive future contributions?

You are given 12 months to complete Healthy Behaviors. You are also given an additional 30 day grace period when contributions begin. 
 
EXAMPLE: You were initially enrolled in the Iowa Health and Wellness Plan January 1, 2016. Your initial 12 months of coverage is between January 1, 2016 and December 31, 2016. If you did not complete your Healthy Behaviors, your contributions would begin January 1, 2017. Your 30 day grace period would begin December 31, 2016 and end on January 30, 2017.
 

I 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 that are submitted. If an exam occurred close to the beginning of the contributions, Iowa Medicaid may not yet have the claim and the official record of the exam. If this occurrs, you may contact the Iowa Medicaid Member Services Unit at 1-800-338-8366 (M-F, 8-5).
 

Where can I find more information about the Iowa Health and Wellness Plan?

For more information about the Iowa Health and Wellness Plan go to http://dhs.iowa.gov/IHAWP and click on "Resources" in the left navigation.
 

What if I need more help?

DHS Application
For assistance with your DHS application you may contact the Iowa Department of Human Services:
  • You can call the toll-free Iowa Department of Human Services (DHS) number: 855-889-7985 (M-F, 7-6).

OR

Iowa Health and Wellness Plan
For assistance with questions about the Iowa Health and Wellness Plan, you may contact the Iowa Medicaid Member Services Unit at 1-800-338-8366 (M-F, 8-5).
 
 
 
 

Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.)
1-800-338-8366 (Toll Free) 
515-256-4606 (Des Moines Area)
515-725-1351 (Fax)
 
For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.
 
Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.