What Does Iowa Total Care Cover

Decoding Healthcare: What Exactly Does Iowa Total Care Provide?


Iowa Total Care is more than just a health insurance provider. As part of the Centene Corporation, it offers a wide range of health services tailored for Iowans. From basic check-ups to specialized treatments, they ensure that everyone gets the care they need. In this article, we’ll break down what Iowa Total Care covers and why it’s a top choice for many residents.

What Does Iowa Total Care Cover

Iowa Total Care offers comprehensive health services for Iowa residents, ranging from preventive care, professional office services, inpatient and outpatient hospital services, behavioral health, outpatient therapy, radiology, durable medical equipment, long-term support, to hospice and home health services, ensuring a holistic approach to healthcare.

Services Covered by Iowa Total Care

Comprehensive Coverage Details

Preventive Services

  • ACA Preventive Services: Covered by Iowa Total Care to ensure members receive essential preventive services without any additional cost.
  • Routine Check-Ups: Regular health check-ups are covered, ensuring members maintain good health.
  • EPSDT for individuals up to age 21: Early and Periodic Screening, Diagnosis, and Treatment services are available for younger members.
  • Immunizations: Covered with some limitations to ensure members are protected against various diseases.

Professional Office Services

  • Primary Care Provider: Members have access to a wide network of primary care providers.
  • Office Visit: Regular office visits are covered.
  • Allergy Testing and Treatments: Allergy-related services are included.
  • Family Planning and Related Services: Comprehensive family planning services are available.
  • Podiatry: Covered with specific conditions.
  • Routine Eye and Hearing Exams: Annual eye and hearing check-ups are included.

Inpatient and Outpatient Hospital Services

  • Preapproval for non-emergent admissions: Necessary for specific treatments and procedures.
  • Room and Board, Inpatient Physician Services, Supplies, and Surgery: All essential inpatient services are covered.
  • Bariatric Surgery: Covered with certain limitations.
  • Outpatient services: Includes Ambulance, Urgent Care Center, and Hospital Emergency Room.

Behavioral Health Services

  • Assertive Community Treatment (ACT): Specialized treatment programs for individuals with severe mental health conditions.
  • Behavioral Health Intervention Services (BHIS): Interventions to address behavioral challenges.
  • Inpatient and Outpatient Mental Health and Substance Abuse: Comprehensive mental health services are available.

Outpatient Therapy Services

  • Cardiac, Occupational, Oxygen, Physical, Pulmonary, Respiratory, and Speech Therapy: A wide range of therapy services to cater to various health needs.

Radiology and Laboratory Services

  • Mammography, Routine Radiology Screening, Sleep Study Testing, Colorectal Cancer Screening: Diagnostic and preventive screenings are covered.

Durable Medical Equipment

  • Medical Equipment and Supplies: Essential medical equipment is covered.
  • Diabetes Equipment: Equipment necessary for diabetes management is included.
  • Eye Glasses and Hearing Aids: Covered with age-specific conditions.

Long Term Support Services (LTSS)

  • Community-Based and Institutional services: Services to support individuals with long-term care needs.

Hospice, Health Homes, and Home Health Services

  • Comprehensive care for individuals requiring hospice, health home services, or home health services.
Routine Check-UpsCovered by Iowa Total Care
EPSDT (up to age 21)Covered by Iowa Total Care
ImmunizationsCovered with some limitations
Office VisitCovered by Iowa Total Care
Allergy TestingCovered by Iowa Total Care
Family PlanningCovered by Iowa Total Care
PodiatryCovered with specific conditions
Eye ExamsCovered annually
Hearing ExamsCovered annually


Excluded Services

While Iowa Total Care offers a comprehensive range of services, there are certain services that are not covered. Here’s a list of services that are not included:

  1. Cosmetic Procedures: Procedures intended solely for cosmetic purposes and not deemed medically necessary.
  2. Experimental Treatments: Treatments not recognized as standard medical practice.
  3. Over-the-Counter Medications: Medications available without a prescription, unless otherwise specified.
  4. Travel Vaccinations: Vaccinations required for international travel not part of the routine schedule.
  5. Weight Loss Programs: Programs intended solely for weight loss without medical necessity.
  6. Non-Essential Elective Surgeries: Surgeries chosen by the patient for non-medical reasons.

Additionally, some services may:

  • Have copays.
  • Have coverage limits.
  • Require a doctor’s order.
  • Need prior approval.

It’s crucial for members to consult the official Iowa Total Care documentation or speak with a representative to get a complete understanding of all exclusions.

Excluded Services by Iowa Total Care

Iowa Total Care Coverage Costs

Here’s a detailed breakdown of the services covered by Iowa Total Care and their associated costs:

ServiceCost with Iowa Total Care
ACA Preventive ServicesCovered
Routine Check-UpsCovered
EPSDT (up to age 21)Covered
ImmunizationsCovered (with some limitations)
Primary Care Provider VisitCovered
Allergy TestingCovered
Family PlanningCovered
Podiatry (specific conditions)Covered
Eye ExamsCovered annually
Hearing ExamsCovered annually
Preapproval for non-emergent admissionsNecessary for specific treatments
Room and Board, Inpatient ServicesCovered
Bariatric Surgery (with limitations)Covered
Outpatient Ambulance ServiceCovered
Urgent Care Center VisitCovered
Hospital Emergency Room VisitCovered
Assertive Community Treatment (ACT)Covered
Behavioral Health Intervention Services (BHIS)Covered
Inpatient Mental HealthCovered
Outpatient Mental HealthCovered
Substance Abuse TreatmentCovered
Cardiac TherapyCovered
Occupational TherapyCovered
Oxygen TherapyCovered
Physical TherapyCovered
Pulmonary TherapyCovered
Respiratory TherapyCovered
Speech TherapyCovered
Routine Radiology ScreeningCovered
Sleep Study TestingCovered
Colorectal Cancer ScreeningCovered
Medical Equipment and SuppliesCovered
Diabetes EquipmentCovered
Eye GlassesCovered (with age-specific conditions)
Hearing AidsCovered (with age-specific conditions)

Cheapest Iowa Health Insurance Comparison

Comparing Iowa Total Care with other health insurance providers in Iowa:

ProviderMonthly PremiumDeductibleOut-of-Pocket Maximum
Wellmark Blue Cross Blue Shield$300$6,750$8,200
Iowa Total Care$250$6,000$7,900

Monthly Premium Comparison

Potential Savings with Iowa Total Care

Comparing the average costs of services in Iowa with the costs under Iowa Total Care:

ServiceAverage Cost in IowaCost with Iowa Total CareSavings
Routine Check-Up$120Covered$120
Allergy Testing$250Covered$250
Family Planning$150Covered$150
Podiatry Visit$200Covered$200
Eye Exam$100Covered$100
Hearing Exam$150Covered$150
Inpatient Hospital Stay (per day)$2,500Covered$2,500
Outpatient Ambulance Service$800Covered$800
Urgent Care Center Visit$250Covered$250
Behavioral Health Intervention Services (BHIS)$300Covered$300
Cardiac Therapy Session$500Covered$500

This comprehensive section provides a clear picture of the costs associated with Iowa Total Care and the potential savings when compared to other providers and average healthcare costs in Iowa.

Potential Savings with Iowa Total Care


Iowa Total Care stands as a beacon of comprehensive healthcare coverage in the state of Iowa. With its wide array of services, from preventive care to specialized treatments, it ensures that its members receive the best possible care without the burden of exorbitant costs. 

Its commitment goes beyond just medical treatments; it encompasses a holistic approach to health, ensuring both physical and mental well-being. By offering such extensive coverage, Iowa Total Care not only addresses immediate health concerns but also invests in the long-term health of Iowa’s residents. 

In a landscape where healthcare costs can be unpredictable, having a provider that prioritizes its members’ health and financial well-being is invaluable. As we’ve delved into the specifics of what Iowa Total Care covers, it’s evident that their mission is to ensure that every resident of Iowa has access to quality healthcare, fostering a healthier and happier community.