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 already have Medicare
  

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) is based on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. This cost depends on your age and location. Moreover, to qualify for financial assistance with your Marketplace plan, you must:

• Not have access to affordable health coverage through your 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.

You can sign up for an ACA-compliant individual or family health insurance in Iowa between November 1 and January 15 during open enrollment.⁵ 

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. 

Some people can enroll in ACA Marketplace plans without a qualifying event, including:

• Native Americans⁶
• People eligible for subsidies with income under 150% of the poverty level (at least until 2025)⁷

People who lose Medicaid/CHIP between March 31, 2023 and July 31, 2024⁸

During open enrollment in Iowa, you can get information and calculate tax credits 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.⁹ 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).

During the 2023 open enrollment period:

• Nearly 8 in 10 eligible enrollees qualified for premium subsidies.¹⁰
• Subsidies (called Advance Premium Tax Credits or APTC) saved Iowans about $568/month on average in 2023.¹⁰
• Those with subsidies paid an average premium of $105 per month.¹⁰
  

Source: CMS.gov¹¹

In addition to APTC, if your household income falls below 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR).¹² CSRs help reduce deductibles and out-of-pocket expenses. 

You may also qualify for affordable Medicaid if eligible. Short-term plans are a low-cost option for people not eligible for Medicaid, Medicare, or subsidies.

In Iowa, three companies sell plans through the exchange, but the options might differ depending on where you live:¹³

• Medica
• Oscar
• Wellmark

Iowa’s individual market insurers have proposed the following average rate increases for 2024:¹⁴ 

Source: Iowa Rate Review Submissions¹⁴

Rate changes apply to full-price premiums. Since nearly 90% of eligible people using the Iowa exchange receive premium tax credits, they generally don’t pay the full premium amount.¹⁵ 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.

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.¹⁰

This increase in enrollment is likely due to the American Rescue Plan (ARP). Under the ARP, ACA’s premium subsidies are more significant and widely available. ¹⁶

Source: 2014,¹⁷ 2015, ¹⁸ 2016,¹⁹ 2017,²⁰  2018,²¹ 2019,²² 2020,²³ 2021,²⁴ 2022,²⁵ 2023, ¹⁶ 2024²⁶

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.