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Residents of Iowa have several health care options. Employers provide most of the coverage in the state; however, you can also select plans from the ACA Marketplace or purchase plans individually from a broker, insurance agent, or health insurance company. Those 65 and older or disabled can qualify for Medicare, while families and adults with limited income may be eligible for Medicare.
This guide explains your health care options in Iowa in detail.
Residents who want to enroll in Iowa’s Health Insurance Marketplace use the Healthcare.gov website. Iowa maintains a partnership with the federal government, which means that while residents use Healthcare.gov to purchase plans, Iowa manages the plans, provides consumer assistance, and determines Medicaid eligibility.
To use Healthcare.gov, you’ll need to register. This involves providing personal information including your Social Security number, the number of people in your household, your household income, your telephone number, your address, etc.
The application will ask you several questions related to your income and family, including the following:
After entering the required information, you’ll be able to view a list of available plans, including monthly premiums, annual deductibles, and coinsurance requirements. HealthCare.gov also allows you to make side-by-side comparisons of up to three plans at a time. Once you pick a plan, you’ll be able to complete the enrollment process.
Three companies offer health care plans to Iowans in 2021 on Healthcare.gov:
Some plans may be available statewide, while others are only available in certain regions or cities.
There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:
When you’re purchasing a health care plan for yourself, your budget and your overall health are the two most important factors to consider. If you have minimal health concerns and don’t require prescriptions, you may be better off looking for a plan that provides a low monthly premium but higher deductibles. If, on the other hand, you have a chronic health condition that requires regular visits to a doctor or a specialist, you’ll want to consider a plan that has a higher monthly premium but a lower deductible.
There are several different plans from which you can choose:
The main difference between a plan sold on Healthcare.gov and one purchased off-exchange is that ACA Marketplace plans offer premium tax credits if your income is between 100% to 400% of the Federal Poverty Level. You’re not eligible for these benefits with off-exchange plans. Plus, if you select a silver plan on the Marketplace, you may also qualify for additional cost-sharing reductions (CSRs).
Purchasing insurance for your family can be a bit more complicated than purchasing health care for yourself. You might be healthy, but your spouse or some of your children may have chronic health conditions such as asthma, high blood pressure, or mental health concerns. The trick will be to balance monthly premiums and out-of-pocket costs. It pays to meet with an insurance company’s broker or an agent and talk to them about your concerns. That way,you’ll get help with finding a plan that works for your family and your budget.
ACA plans sold on Healthcare.gov are organized into metal tiers: bronze, silver, gold, and platinum. However, you shouldn’t assume that a bronze plan will result in reduced health care coverage. All plans offered on the ACA marketplace offer the same comprehensive health care. The difference is what you’ll pay for the health care you received.
|Average premiums in Iowa||2018||2019||2020||2021|
|Most affordable bronze plan||$570||$467||$398||$311|
|Most affordable silver plan||$713||$662||$636||$481|
|Most affordable gold plan||$793||$607||$527||$443|
Iowa operates an expanded Medicare program aimed at providing health care to low-income individuals and families. Eligibility is based on income compared to the Federal Poverty Level and your countable assets.
You may be eligible for Medicaid in Iowa if you are an Iowa resident and U.S. citizen or a permanent resident or legal alien in need of health care assistance and fall into one of the following categories:
Medicaid covers a variety of health care services, including laboratory tests, X-rays, hospital care, family planning, and home health. Your eligibility for Medicaid is dependent upon income limits, including resources such as cash, bonds, stocks, certificates of deposit, and money in a checking or savings account. Resource or asset limits in Iowa are $2,000 for an individual and $3,000 for a couple. Your home, the appliances in your home, and one vehicle are not used to calculate asset limits.
HAWKI provides health care to uninsured children of working families. Many families pay nothing for the program; however, no family will pay more than $40 a month.
Health care coverage includes:
Iowans who are at least 65 or disabled (even if less than 65) can enroll in Medicare, the federal government’s health insurance program.
If you’re worried about out-of-pocket costs incurred with Original Medicare, consider adding a Medicare Supplement Insurance Plan. These plans cover copays, coinsurance, and deductibles. However, it won’t help you with the cost of vision, hearing, or dental, nor can you use a Medicare Supplement Insurance Plan to cover long-term care costs. If you’re planning on traveling outside the United States, a Medicare Supplement Insurance Plan will provide health coverage while you’re abroad. If you have a Medicare Advantage Plan, you cannot purchase a Medicare Supplement Insurance Plan.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months’ worth of payments from the Social Security Disability Insurance program. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
The Senior Health Insurance Information Program (SHIIP) provides free, unbiased, and confidential assistance needed to make decisions about Medicare to beneficiaries in Iowa, their families, or their caregivers.. The certified, trained counselors advocate, inform, educate, and assist seniors and the disabled about Medicare issues and related health care issues to help them make informed decisions.
Yes. Short-term insurance programs in Iowa follow federal rules regarding duration. Plans can have initial terms of 364 days and can be renewed up to three times.
No. The ACA originally mandated that every adult in the U. S. needed to have health care or pay a tax penalty. In 2019 this part of the law was rescinded by the United States Supreme Court. While some states have enacted their own healthcare laws, Iowa is not one of them.
No, you can also purchase health care in Iowa through a broker, an agent, or an individual health insurance company.
Faith-based programs are the most common form of cost-sharing plans in Iowa. Costs are shared between members of a plan. However, you don’t need to belong to a denomination (or even be religious) to join a plan. While relatively inexpensive, these plans may not cover pre-existing conditions or other forms of essential health care. If you’re considering joining a faith-based plan, make sure you review its coverage and financial limit rules.
Yes. Saving enough money to pay for a serious medical emergency with an HSA/FSA account would be difficult, if not impossible. These accounts are primarily designed to pay for deductibles, copays, or coinsurance.
It depends on your job. Disability coverage pays for household expenses when you’re injured. These costs are not covered by health insurance. If you have a job where injury is a possibility, you should consider short-term disability coverage.
Health insurance does not pay for the same things that disability coverage does. If you work in a job where injury is possible, purchasing a long-term disability plan is a good idea.