The Hawkeye State has three carriers for 2021 Marketplace plans.
Iowa Health Insurance Overview
Iowa has a low uninsured rate. As of 2018, about 151,000 residents have no health insurance. This group accounts for 5% of the state’s 3 million population.1
Roughly 1.2 million Iowans are enrolled in government health insurance programs: Medicaid and Medicare. A small number of residents have private coverage from the federal Health Insurance Marketplace. The majority of these individuals qualify for help with premium costs.
Iowa and the Affordable Care Act (ACA)
The Hawkeye State had lower than average uninsured rates even before the passage of the 2010 Affordable Care Act (or Obamacare). As far back as 2008, Iowa’s uninsured was 9% while the U.S. average was 15%. Rates have remained in the single digits since then.2
Iowa’s acceptance of Medicaid expansion under the ACA contributed to fewer uninsured residents. In 2014, the state expanded Medicaid eligibility to childless adults earning up to 138% of the federal poverty level.3 This change led to 155,000 more residents with health insurance as of October 2019.4
Buying Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs
Most Iowans get private health insurance through an employer. But you can also get it through Obamacare plans sold in the Marketplace. The Marketplace in Iowa is facilitated through the federal Healthcare.gov website.
If you’re self-employed with no employees, you have the same options as individuals and families. You can choose from any Obamacare plan available in your area. These come in bronze, silver, gold, and platinum. Each metal plan pays for a certain percentage of covered care from 60% (bronze) to 90% (platinum).
All Obamacare policies provide essential health benefits, such as prescription drug coverage, hospitalization, and maternity care. They must also cover preexisting conditions. Companies are not allowed to deny you a policy due to health conditions.
Iowa Health Insurance Marketplace Enrollment
Nearly 55,000 Iowans bought Marketplace health insurance during the 2020 Open Enrolled Period (OEP).5 This number rose slightly from the roughly 49,000 residents who signed up during the previous year.6
Iowa’s open enrollment for 2021 coverage begins on November 1, 2020 and ends on December 15, 2020. If you missed signing up, you can enroll at any time if you have a qualifying life event, such as marriage or childbirth.
Special Enrollment Period
Iowans can enroll in a health plan during a Special Enrollment Period created due to the coronavirus. The federal government reopened enrollment from February 15, 2021 through August 15, 2021.
Health Insurance Companies in Iowa
- Medica Insurance Company
- Wellmark Health Plan of Iowa
- Oscar Health Plan of Iowa
Health Insurance Costs in Iowa
Iowa health insurance premiums for 2020 Marketplace plans fell from 2019.
Premiums for gold and bronze policies dropped the most (13 to 15%).
Here’s a look at the average monthly rates for Iowa Marketplace plans:
- Average lowest-cost bronze plan: $398 in 2020 | $467 in 2019
- Average lowest-cost silver plan: $636 in 2020 | $662 in 2019
- Average lowest-cost gold plan: $527 in 2020 | $607 in 2019
Financial Help With Iowa Marketplace Plans
The federal government provides financial help based on your income and household size. You can get premium tax credits (subsidies) to lower monthly payments, cost-sharing reductions (CSRs) on eligible out-of-pocket expenses, or both. You must enroll in coverage through the Marketplace to get assistance.
Iowans can earn up to 400% of the federal poverty level (FPL) to qualify for subsidies. In 2020, this amounts to $52,040 for a single person and $104,800 for a family of four.8
The income limit for CRSs is much lower at 250% of the FPL, or up to $31,900 for a single adult in 2020.9
For the 2019 plan year, 92% of Marketplace enrollees in Iowa received federal help with monthly premiums; another 36% got cost-sharing reductions.10 The average subsidy in Iowa was $881 per month. This amount is one of the highest monthly subsidies in the country.
Check a 2020 subsidy chart and calculator to see which subsidies you might qualify for.
Medicaid for Low-Income Iowa Families, Children, Pregnant Women, Seniors, and People With Disabilities
Some people can’t afford private health insurance, even with subsidies. That’s where Medicaid comes in. It offers low-cost or no-cost health insurance to eligible residents who meet income requirements.
Medicaid offers comprehensive health coverage similar to Obamacare plans. Benefits are provided through three Iowa Medicaid programs:
- IA Health Link (Iowa Health and Wellness Plan): This is a managed care plan that coordinates your healthcare. You must be 19 to 64 and earn no more than 133% of the FPL to qualify ($16,971 for a single person in 2020). Most Iowans on Medicaid get managed care.
- Medicaid Fee-For-Service (FFS). With FFS, participating providers bill Medicaid directly when you receive care. It includes programs that serve adults, including those who also qualify for Medicare, parents, and caretakers of children 19 and under, pregnant women, and the elderly.
- Healthy and Wealthy Kids in Iowa (Hawki): This is a Children’s Health Insurance Program (CHIP). It covers uninsured children of working families. Some families pay no premium for CHIP; others who do, pay no more than $40 a month.
Medicare for Iowa Seniors and Adults Under 65 With Disabilities
Medicare is a federal health insurance program. Unlike Medicaid, there are no income requirements. Most Iowans who qualify do so upon turning 65. Younger adults with disabilities and certain illnesses are also eligible.
More than 623,000 Iowans have Medicare as of 2018. The majority (81%) are enrolled in Original Medicare, and the rest have private Medicare Advantage plans.
This is the traditional program run by the government. It provides coverage for inpatient hospital (Part A) and outpatient medical care (Part B). Outside of a hospital, most medications aren’t covered. So many Iowans (about 384,000) buy private Medicare Part D prescription drug plans.12
Medicare Advantage (Part C)
This an alternative to Original Medicare. It includes Part A and B, and most plans come with Part D drug coverage. Some policies also provide extra benefits like routine dental, vision, and hearing care.
Private insurers also offer Medicare Supplement plans, commonly called Medigap. You must have Original Medicare to buy Medigap. Policies help pay some to all of your Part A and B out-of-pocket expenses, including deductibles, coinsurance, and copayments. Iowa, like most states, offers 10 standard Medigap plans.
Iowa Short-Term Health Insurance If You’re In a Temporary Coverage Gap
Short-term health insurance is ideal when you have a temporary gap in coverage. Some of these situations include missing the annual Obamacare enrollment period, aging off your parent’s health plan when you turn 26, or waiting for new employer benefits to start.
You can buy a policy in Iowa lasting up to 364 days and renew it for up to 36 months.13 Keep in mind that short-term plans are not the same as qualified health insurance under the Affordable Care Act. They don’t provide major medical coverage and are not required to cover preexisting conditions. Companies can also deny you a policy based on your health.
As of 2020, Iowa authorizes the following companies to sell short term coverage for up to 364 days:14
- Golden Rule Insurance Company
- National Health Insurance Company
- Companion Life Insurance Company
- United States Fire Insurance Company
- First Chicago Insurance Company
Before you buy a short-term policy, compare options from different insurers and make sure you understand the limitations. You should also see how short-term plans compare to Obamacare health plans in Iowa.