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.

What to know about insurance in Iowa

  • Marketplace plans: Iowans not covered by an employer’s insurance policies can purchase or access a health care plan in several ways, such as on the Health Insurance Marketplace, through a broker, insurance agent, or an individual health insurance company. Iowans over the age of 65 or disabled are eligible for Medicare, while low-income single adults and families are eligible for Medicaid. Iowans can also purchase short-term insurance that can provide coverage during times when there’s a gap in full health care coverage.
  • Open Enrollment: The Open Enrollment Period for purchasing plans on Healthcare.gov normally runs between November 1 to December 15 each year.
  • Special Enrollment: If you miss the open enrollment window, the only way to purchase a plan from Healthcare.gov is if you have a qualifying event. Getting married, having a baby, moving, changing or losing your job, or if you have had a change in eligibility for Medicare or Medicaid are all qualifying events. You have 60 days from the time of the event to sign up for a new plan or make changes to your current plan.
  • Premium tax credit: Under the Affordable Care Act (ACA), full health care plans must cover pre-existing conditions, provide for mental health coverage, and not charge extra for these benefits. This is true of all ACA-compliant plans both on and off the exchange, you’ll only get a premium tax credit if you apply through the exchange.
  • Coverage types: The majority of Iowans receive health insurance through an employer, about 54%. The next largest groups are recipients of Medicaid at 19.5% and then older or disabled Iowans on Medicare at 15.6%. Nongroup insurance (plans bought off-exchange or short-term health care policies) account for 4.9%. Military plans account for 0.9%. Iowa has one of the lowest rates of uninsured residents in the nation at 4.7%.

How do I enroll in Iowa’s Health Insurance Marketplace?

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:

  • Are you single or married?
  • How many tax dependents will you claim on your current return?
  • How much income will your household make this year?
  • Do you want to see if you can get help paying for coverage?

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:

  • Medica
  • Oscar
  • Wellmark

Some plans may be available statewide, while others are only available in certain regions or cities.

How do I enroll in Iowa’s individual and families insurance?

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

  • Medical needs
  • Preferred plan type
  • Premium affordability
  • Individual vs. family deductibles

Insurance for individuals in Iowa

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:

  • A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
  • A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

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).

Insurance for families in Iowa

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.

How much does health insurance cost in Iowa?

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

  • Bronze plans feature low monthly premiums, high deductibles, and coinsurance fees of 40%. These are good plans for people who don’t require frequent visits to a doctor’s office (or regular prescriptions) and want to keep health care costs to a minimum. The lowest-priced bronze Plan in Iowa has a monthly premium of $311.
  • Silver plans are a good option for individuals or families looking to capitalize on the tax credits and benefits available on the ACA marketplace or who may have some consistent health care concerns. These plans have a higher monthly premium but feature lower deductibles and a coinsurance payment of only 30%. If your income is between 100% and 400% of the Federal Poverty Level, then you meet the eligibility requirements for tax credits. As a result, a silver plan can often cost less than a bronze plan. The most affordable silver plan in Iowa, before calculating any benefits, is $481 a month.
  • Gold or platinum plans are good choices if you, or a member of your family, have a chronic health condition that requires regular treatment. These plans feature low deductibles and the lowest coinsurance payments of any tier — 20% for a gold plan and 10% for a platinum plan. You’ll pay a lot less in out-of-pocket expenses. The drawback is that these plans typically have heftier monthly premiums. In Iowa, the lowest-priced gold plan is $443 a month.

What kind of low-income health insurance is available in Iowa?

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.

Medicaid in Iowa

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:

  • You are under the age of 21
  • You are pregnant
  • You are a woman who needs treatment for breast or cervical cancer
  • You are a parent of a child or children who are under the age of 18
  • You are aged 65 or older
  • You are disabled
  • You are between the ages of 19 and 64, and your income is at or below 133% of the federal poverty level

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.

Healthy and Well Kids in Iowa (HAWKI)

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:

  • Doctor’s visits
  • Specialists
  • Immunizations
  • Hospital care
  • Surgeries
  • Out-of-network coverage
  • Eye exams
  • Eyeglasses and contact lenses
  • Mental health services
  • Prescriptions

What are Iowa’s Medicare options for seniors and people with disabilities?

Iowans who are at least 65 or disabled (even if less than 65) can enroll in Medicare, the federal government’s health insurance program.

  • Original Medicare includes Part A (home health care, hospitalizations, hospice) and Part B (doctor’s visits, durable medical equipment, mental health care). Part A can cost around $470 a month, depending upon how much you’ve paid in Medicare taxes. Part B will always have a $148.50 monthly premium. Original Medicare does not include prescription drug coverage, so if you require regular medications, you’ll need to purchase a Medicare Part D plan. There are also no out-of-pocket limits on Original Medicare.
  • Medicare Advantage is another option for seniors and the disabled in Iowa. Also known as Medicare Part C, these are individual health plans approved by Medicare. There are four types of Medicare Advantage Plans: HMO, PPO, Private Fee-For-Service, and Special Needs. Medicare Advantage Plans provide dental, vision, and hearing coverage and many plans provide fitness memberships and prescription drug coverage. In 2019 there were 42 Medicare Advantage Plans available in Iowa. However, you can only select a Medicare Advantage Plan available in the county in which you live.

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.

Eligibility

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).

Enrollment

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:

  • Initial Enrollment: begins three months before you turn 65, the month of you turn 65, and three months after your birthday
  • Medicare Advantage open enrollment: You can enroll in Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open Enrollment: You can enroll between October 15 and December 7. You can move from Original Medicare to a Medicare Advantage Plan, return to Original Medicare from a Medicare Advantage Plan, or switch between Medicare Advantage Plans
  • Special enrollment periods: You are eligible for special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

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.

Are there short-term health insurance plan options in Iowa?

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.

Iowa insurance FAQ

Does Iowa require health insurance?

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.

Do I have to use the Health Insurance Marketplace in Iowa?

No, you can also purchase health care in Iowa through a broker, an agent, or an individual health insurance company.

What types of alternative health insurance plans (like cost-sharing plans) are available in Iowa?

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.

Do I need health insurance in Iowa if I have HSA/FSA?

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.

Do I need short-term disability coverage in Iowa if I have health insurance?

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.

Do I need long-term disability coverage in Iowa if I have health insurance?

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.

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Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

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