The University of Iowa Retirees are offered two Medicare Advantage plans with Part D administered by Health Alliance. If choosing one of these plans, you will receive top-notch coverage and a large network of doctors, hospitals, and clinics.
Brief Comparison of Both Plans
The two plans you can choose from are the University of Iowa HMO Rx Plus Plan or a custom PPO Rx plan that closely matches the benefits you had with UIChoice and UISelect. Coverage under these plans qualifies as Qualifying Health Coverage (QHC) and satisfies the Patient Protection and Affordable Care Act's (ACA) individual shared responsibility requirement.
| Plan Provision | UI HMO Rx Plus | UI PPO Rx |
|---|---|---|
| Definition of HMO and PPO | Health Management Organization (HMO): personal care from a set network. You'll need a PCP to manage your care and refer you to specialistspecialists. You must go to certain doctors and hospitals, unless it's an emergency/urgent care. | Preferred Provider Organization (PPO): This plan also allows you to visit certain doctors and hospitals, and you have the freedom to go out-of-network. However, you will pay less if you go to in-network doctors and hospitals. |
| Premiums | $60/month | $320/month |
| Out-of-Pocket Max | $4,000 | $2,000; combined in-network/out-of-network |
| Deductible | $0 | $0; both in-network/out-of-network |
| Primary Care and Specialist Care Visit | $10 copay primary; $35 copay Specialist | $5 copay in-network, 40% coinsurance out-of-network for both primary and specialist visits |
| Emergency Room | $90 copay | $50 copay + 10% coinsurance in-network/out-of-network |
| Urgent Care | $55 copay | $5 copay in-network; 40% coinsurance out-of-network |
| Inpatient Hospital | $280/day (days 1-7); $0/day (days 8+) | 10% coinsurance in-network; 40% coinsurance out-of-network |
| Outpatient Hospital | $275 copay | 10% coinsurance in-network; 40% coinsurance out-of-network |
| Ambulance | $275 copay | 10% coinsurance in-network; 40% coinsurance out-of-network |
| Diagnostic Tests, X-rays, Labs & Radiology | 20% coinsurance | 10% coinsurance in-network; 40% coinsurance out-of-network |
Coverage for Dependents
Retirees may cover dependents under age 65 on their UI Health Alliance plan as long as the dependent has both Medicare parts A and B.
Examples include:
- A dependent child over age 26 who is disabled and is on both parts A & B or
- A spouse/partner who is disabled, under 65, and already on Medicare A & B.
Please visit the UI Health Alliance website to review the details of each Health Alliance plan.
| 2024 Health alliance Documents | UI Retiree Plan Documents |
|---|---|