Iowa Health Insurance Consumer Guide

Anyone who meets the following criteria can buy Marketplace health coverage in Iowa:

• You must live in Iowa
• You must be a U.S. citizen, national, or lawfully present
• You must not be incarcerated
• You must not be enrolled in Medicare
  

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) is based on your income. Moreover, to qualify for financial assistance with your Marketplace plan, you must:

• Not have access to affordable health coverage through an employer. If your employer offers coverage, but you feel it’s too expensive, use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not qualify for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁷
• If married, file a joint tax return.⁸
• Not be able to be claimed by someone else as a tax dependent.⁸

You can sign up for an ACA-compliant individual or family health insurance in Iowa between November 1 and January 15 during open enrollment.⁹ 

Here are some key dates to remember: 

• If you enroll by December 15, your coverage starts on January 1. 
• If you enroll between December 16 and January 15, your coverage begins on February 1. 

If you miss open enrollment, you may still get coverage through the Marketplace if you have a qualifying life event. Examples of qualifying life events include loss of health coverage, gaining a dependent, or permanent relocation (assuming you already had coverage prior to the move). 

Some people can enroll in ACA Marketplace plans year-round without a specific qualifying event, including:

• Native Americans¹⁰
• People eligible for subsidies with income up to 150% of the poverty level.¹¹ 

People who lose Medicaid/CHIP between March 31, 2023 and November 30, 2024 can enroll in a Marketplace plan at any point during that time, and are not limited to the normal 60-day deadline to sign up for new coverage.¹²

You can enroll in an Iowa health insurance Marketplace plan by:

• Visiting HealthCare.gov
• Calling 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.
  

You can also find local help from local insurance agents, brokers, certified application counselors or an approved enhanced direct enrollment entity.¹³ They can review options and help you pick a plan to fit your needs. Find local help at localhelp.HealthCare.gov

You can find affordable health plans in Iowa on the ACA Marketplace (HealthCare.gov).

As of early 2024:

• Nine out of ten Iowa Marketplace enrollees qualified for premium subsidies.¹⁴
• These premium subsidies (called Advance Premium Tax Credits or APTC) saved Iowa Marketplace enrollees about $508/month on average in 2024.¹⁴
• Across all Iowa Marketplace enrollees, including the 10% who paid full price, average net premiums amounted to about $127/month.¹⁴
  

(Note that the chart below shows data for everyone who signed up during the open enrollment period for 2024 coverage, while the data above is for effectuated enrollments as of early 2024.)

Source: CMS.gov¹⁵

In addition to APTC, if your household income isn’t more than 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR). CSRs help reduce deductibles and out-of-pocket expenses. Note that you must select a Silver-level plan to take advantage of CSR benefits.

Depending on your household income, you may qualify for Iowa Medicaid instead of Marketplace subsidies. Short-term plans can be a low-cost option for people not eligible for Medicaid, Medicare, or Marketplace subsidies (as of September 2024, new short-term policies are limited to initial terms of no more than three months, and total duration, including renewals, of not more than four months).

As of 2023, there were still nearly 30,000 people in Iowa who were enrolled in individual grandfathered or grandmothered health plans.¹⁶ These plans do not have to comply with various aspects of the ACA, and people enrolled in these plans cannot get the financial assistance that’s available via the Iowa Health Insurance Marketplace. If you’re enrolled in a pre-2014 health plan, it’s important to double-check your options in the Iowa Marketplace during open enrollment, to see if a newer plan might provide better coverage and/or lower premiums.

In Iowa, three companies sell plans through the exchange in 2024. This is growing to five in 2025. The Iowa Insurance Division has confirmed that two carriers — Medica and Wellmark Health Plan of Iowa — will offer plans statewide in 2025. The other three carriers will offer plans in some counties but not others: Iowa Total Care will offer plans in 33 counties. Oscar will offer plans in 75 counties, and UnitedHealthcare Plan of the River Valley will offer plans in 17 counties.¹⁷

UnitedHealthcare and Iowa Total Care (Ambetter) are new for 2025,²³ bringing the number of participating insurers to five in Iowa’s Marketplace.¹⁷

And two of the three current insurers have proposed average rate decreases.⁴

Iowa’s individual market insurers have proposed the following average rate changes for 2025.⁴ (Rates are under review by state regulators and will be finalized before open enrollment begins in November 2024; average rate changes are calculated before subsidies are applied.)

Source: RateReview.HealthCare.gov,⁴ UnitedHealthcare² and Centene/Ambetter³

Rate changes apply to full-price premiums, but 90% of Iowa exchange enrollees receive premium tax credits and thus don’t pay the full premium amount themselves.¹⁴ If you qualify for subsidies, your actual rate change will depend on your plan and the subsidy amounts. Your age can also affect your premium too. 

If the cost of your current plan increases, you can explore other health plans in the exchange that may be more affordable and offer similar benefits. (Keep in mind that a net cost increase can happen because of a subsidy decrease due to a reduction in the cost of the benchmark plan.)

For perspective, here’s a summary of how full-price (unsubsidized) average premiums have changed in Iowa’s individual/family health insurance market over the years:

• 2015: Average increase of 11%.¹⁸
• 2016: Average increase of 22.3%.¹⁹
• 2017: Average increase of 28.8%.²⁰
• 2018: Average increase of 51%.²¹
• 2019: Average decrease of 7.9%.²²
• 2020: Average decrease of 10.8%.²³
• 2021: Average decrease of 0.2%.²⁴
• 2022: Average increase of 6.6%.²⁵
• 2023: Average increase of 2.3%.²⁶
• 2024: Average decrease of 5.5%²⁷

During the open enrollment period for 2023 coverage, a record high for Iowa’s exchange was reached, with over 80,000 people signing up for private individual market plans.²⁸

This increase in enrollment is likely due to the American Rescue Plan (ARP). Under the ARP, the ACA’s premium subsidies are more significant and widely available.²⁹ These subsidy enhancements have been extended through 2025 by the Inflation Reduction Act.

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023, ²⁹ 2024³⁹

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

Iowa Insurance Division
Get information about insurance and other products regulated by the Iowa Insurance Division (IID). You can also file complaints about insurance with the IID.

Iowa Comprehensive Health Association (HIPIOWA)
If you have been denied coverage, the HIPIOWA may offer you access to health insurance. 

Iowa Senior Health Insurance Information Program (SHIIP)
Helps answer questions and provide help to Medicare beneficiaries.