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Financial help for Iowa Medicare enrollees

Medicaid estate recovery in Iowa applies to all Medicaid beneficiaries age 55+, including Medicaid expansion enrollees

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This page describes resources available to Iowans to help pay for Medicare coverage. It also provides an overview of Medicaid programs to help qualifying applicants pay for long-term care, which Medicare doesn’t usually cover.

Does Iowa help with my Medicare premiums?

Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). This program pays for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.

  • Qualified Medicare Beneficiary (QMB): QMB pays for Part A and B cost sharing as well as Part B premiums.  QMB will also pay Part A premiums if a beneficiary owes them. The income limits for QMB are $1,083 a month if single or $1,457 a month if married.
  • Specified Low-income Medicare Beneficiary (SLMB): SLMB pays for Part B premiums. The income limit for SLMB is up to $1,296 a month if single or $1,744 a month if married.  
  • Expanded Specified Low-income Medicare Beneficiary (E-SLMB): E-SLMB pays for Part B premiums for beneficiaries with income up to $1,456 a month if single or $1,960 a month if married.
  • Qualified Disabled Working Persons (QDWP): QDWP pays Part A premiums owed by certain disabled beneficiaries who have returned to work. Few beneficiaries enroll in QDWP due to other Medicaid benefits available to disabled workers. The income limit is $2,126 a month if living alone and $2,873 a month if living with one other person.

MSP asset limits: Iowa uses the federal asset limits for QMB, SLMB and QI: $7,860 if single and $11,800 if married. The QDWI asset limit is $4,000 if single and $6,000 if living with others.

Who’s eligible for Medicaid for the aged, blind and disabled in Iowa?

Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for those additional services if they’re enrolled in regular Medicaid benefits for the aged, blind and disabled (Medicaid ABD).

In Iowa, Medicaid ABD covers comprehensive dental care, including diagnostic and preventive services, fillings, root canals, dentures and crowns. Some members have to pay a monthly premium for this coverage.

Most Medicaid ABD enrollees in Iowa have transitioned to the Iowa Wellness Plan, which has a $1,000 annual benefit maximum for services that aren’t preventive, diagnostic or emergency in nature. That program can require payment of premiums and completion of “health behaviors” to receive full dental benefits.

Enrollees still receive their dental benefits through the fee-for-service Medicaid program if they have a Medicaid spend-down, receive retroactive coverage, are enrolled in Program for All-Inclusive Care for the Elderly (PACE) or live in a nursing home.

Medicaid ABD covers a yearly eye exam and pays for a pair of eyeglasses every two years. (Eyeglasses are covered more frequently for enrollees with medical conditions impacting the eye.)

Income eligibility: The income limit is $783 a month if single and $1,175 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.


Medicaid spend-down for regular Medicaid ABD benefits or long-term care in Iowa

In Iowa, applicants who have incomes greater than the eligibility limit for Medicaid can enroll in the Medicaid spend-down program. This benefit allows enrollees to qualify for Medicaid by subtracting medical and long-term care expenses from their income counted toward the Medicaid eligibility limit.

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The amount that an applicant’s income exceeds the limit for Medicaid spend-down is known as “excess income.” Enrollees must activate their coverage by submitting incurred medical bills equal to this amount. Some states also allow enrollees to pay their excess income directly to Medicaid if they are unable to submit medical expenses.

In Iowa, coverage under the Medicaid spend-down lasts one month at a time. Enrollees have to submit additional medical expenses to receive further coverage.

The Medicaid spend-down program covers long-term care in Iowa.

Income limit:  The income limit is $483 for both singles and couples (as of 2018).

Asset limits: The asset limit is $10,000 for both single applicants and spouses.

Assistance with prescription drug costs in Iowa

Medicare enrollees who have Medicaid, an MSP, or Supplemental Security Income (SSI) also receive Extra Help. This federal program lowers drug costs under Medicare Part D. Enrollees that don’t receive this benefit automatically can apply for it themselves. The income limit is $1,615 a month for singles ($2,175 a month for couples), and the asset limit is $14,610 for individuals ($29,160 for spouses).

How does Iowa regulate long-term services and supports (LTSS)?

Long-term care is an increasingly needed benefit in the U.S. given the aging population, but it is generally not covered under Medicare. However, Medicaid does cover long-term services and supports (LTSS) for people who meet eligibility requirements.

Medicaid nursing home coverage

Most seniors who needed long-term care used to receive it in nursing homes. Today, more enrollees receive long-term care at home. But medical conditions or living situations can make nursing home care a better choice.

Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying). Only income of the spouse who needs nursing home benefits is counted toward this limit.

Nursing home enrollees are required to pay most of this allowed income to their nursing home, but may keep money to pay for health insurance premiums, such as Medicare Part B, Medicare Advantage and Medigap).

Assets limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). If only one spouse has Medicaid, federal rules allow the other to keep up to $128,640. Certain assets are never counted toward this asset limit, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car.

Home and Community Based Waiver (HCBS) services

Every state’s Medicaid program covers long-term care services called Home and Community-Based Waiver (HCBS) services. These services provide coverage for care provided to the beneficiary in a community setting (i.e., not in a nursing home). Applicants must show that they can live safely in their home or assisted living facility.

Income limits: The income limit is $2,349 a month if single and $4,798 a month if married (and both spouses are applying). When only one spouse needs HCBS, only income received by that spouse is counted toward this limit.

Asset limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying). Federal rules allow spouses who don’t have Medicaid to keep up to $128,640.

Spousal impoverishment protections in Iowa

Normally with Medicaid benefits, the income of both spouses is counted for determining eligibility. However, Medicaid LTSS look at just the applying spouse’s income.

Spousal impoverishment rules allow the non-applying or “community spouse” of a Medicaid LTSS recipient to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income.

In Iowa in 2020, spousal impoverishment rules allow community spouses to keep:

Qualifying for Medicaid using a Miller Trust in Iowa

As an alternative to Medicaid spend-down, Iowa allows these applicants to become eligible for LTSS benefits by depositing income each month into a Qualified Income Trust, which is also called a “Miller Trust.”

Even though it is first deposited into the Miller Trust, nursing home enrollees must pay almost all of this income toward nursing home care. However, Iowa allows HCBS recipients to keep all their income up to the Medicaid eligibility limit as a personal needs allowance.

Medicaid applicants in Iowa can use a Miller Trust to qualify for Medicaid nursing home or HCBS benefits, but not regular Medicaid ABD (if they don’t also need long-term care Medicaid).

Iowa requires that applicants have incomes below 125 percent of the cost of institutional care in order to qualify for Medicaid long-term care using a Miller Trust. Individuals with higher incomes can usually afford those services without help from Medicaid.

Permitted home equity in Iowa

Iowa limits Medicaid LTSS applicants to a home equity interest of $595,000 or less.

Penalties for transferring assets in Iowa

Individuals sometimes give away or transfer assets to others so they can qualify for Medicaid LTSS benefits. To discourage asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who “gift” or transfer assets for less than market value, and allows states to use a penalty period for HCBS.

Iowa has a penalty period for HCBS and nursing home benefits. This penalty is based on a 60-month lookback period, when applicants aren’t allowed to make these asset transfers or gifts, and is calculated by dividing the amount of money transferred or given away by the private pay rate for nursing home care. (That rate is $7,205.40 per month in Iowa.)

This manual contains more information about the asset transfer penalty in Iowa.

Estate recovery in Iowa

State Medicaid agencies must attempt to recover what they paid for LTSS and related medical expenses while an enrollee was 55 or older. States can also recover payments for all other Medicaid benefits, and recover from enrollees who didn’t receive long-term care. Estate recovery is sometimes called a claw back.

Iowa chooses to pursue estate recovery against all recipients of Medicaid-covered services who were 55 or older. This includes people aged 55 or older who were enrolled in Iowa’s ACA Medicaid expansion, the Iowa Health and Wellness Program. The state also recovers from the estates of beneficiaries under the age of 55 if they were permanently institutionalized.

When Medicaid coverage was administered by an insurer (called a Managed Care Organization), the state will attempt to recover what it paid that insurer. This amount could be more or less than the actual cost of Medicaid services received.

Iowa Medicaid may waive estate recovery in certain circumstances, including if inheritors of an estate have a monthly income below 200 percent of the federal poverty level or they have less than $10,000 in savings.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009. Medicaid will not try to recover what it paid for MSP benefits after that date, but may try to recover benefits it paid through that date.

Where can Medicare beneficiaries get help in Iowa?

Iowa’s SHIP-SMP

Free-of-charge Medicare enrollment help and counseling is available by contacting Iowa’s SHIP-SMP at 1-800-351-4664. This is the State’s Health Insurance Assistance Program. The program’s website lists the SHIP-SMP offices in each county.

Elder Law Attorneys

Elder law attorneys can assist individuals in accessing Medicaid long-term care benefits. Search for a local elder care attorney on the National Academy of Elder Law Attorneys (NAELA) website.

Area Agencies on Aging

Iowa’s Area Agencies on Aging provide information and services about the assistance programs available to older adults and people with disabilities.

This website contains a list of regional AAA offices in Iowa.

Where can I apply for Medicaid in Iowa?

The Iowa Department of Healthcare and Family Services administers Iowa’s Medicaid program, including determining eligibility for benefits and overseeing private managed care organizations.

You can read more about applying for Medicaid or contacting member services in Iowa.


Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.

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