Iowa lawmakers set out to establish a state-federal partnership health insurance marketplace in December 2012. Some states established a purely state-run marketplace, and others rely solely on the federal marketplace. Iowa used a partnership at first. By 2016, however, the Iowa Marketplace will be fully state-based.
Individuals can purchase their own health insurance plans through the marketplace. Small business owners can purchase a plan for their employees as well. The Small Business Health Options Program (SHOP) allows employers with 50 employees or fewer to shop and compare options for their company.
As of July 2015, three companies have applied to offer health insurance plans through Iowa’s marketplace. Some will offer individual plans only. Some will offer plans for small businesses only.
These companies include:
- Coventry Health Care of Iowa
Iowa’s largest health insurance provider, Wellmark Blue Cross and Blue Shield is not part of the exchange.
By law, all health insurance plans offered through a federal- or state-run exchange must cover the following 10 essential services:
- check-ups, including doctors’ visits and annual physicals
- chronic disease management, such as diabetes care
- outpatient services
- emergency care
- in-patient hospital services
- maternity and newborn care
- mental healthcare, including services for substance abuse problems
- rehabilitative services
- laboratory services
- pediatric care
Adults can purchase vision and dental insurance through the marketplace for an additional fee. Children’s health insurance plans already cover dental and vision programs.
You may be eligible to buy one of five different types of health insurance plans through Iowa’s Marketplace. Each type of plan offers varying levels of expense for premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums.
These five levels of health insurance are:
- Platinum: Your plan covers 90 percent; you pay 10 percent.
- Gold: Your plan covers 80 percent; you pay 20 percent.
- Silver: Your plan covers 70 percent; you pay 30 percent.
- Bronze: Your plan covers 60 percent; you pay 40 percent.
- Catastrophic: These plans pay less than 60 percent of your costs in a year and are designed to be used only in the event of an emergency or catastrophic event. They’re only available to people under the age of 30 or those who qualify for a special exemption.
You’ll use the federally run Healthcare.gov portal to apply for these insurance plans. Once you apply, you’ll be able to compare your options.
The application process will also help you determine if you’re eligible for Iowa’s Medicaid program. Medicaid is a health insurance program for low-income individuals and families. If you qualify for Medicaid, you will finish applying for that type of insurance rather than continuing your application through the marketplace.
Your health insurance rate will be based on your age, history of tobacco use, and your geography. Iowa is divided into seven geographic rating areas. People living in different geographical regions may pay different prices for the same metal (bronze, silver, gold, or platinum) level.
According to the Kaiser Foundation’s Health Insurance Marketplace Calculator, a 30-year-old Iowa resident who does not use tobacco can expect to pay an average of $275 per month for their insurance premiums. That does not factor in any financial assistance from subsidies or tax credits.
When the Affordable Care Act, also known as Obamacare, was established, it set up a system for financial aide. This financial aide is designed to help individuals offset the cost of their health insurance premiums. These subsidies and tax credits are determined based on financial need. Not everyone will qualify.
You may qualify for lower premiums if your annual income falls within a certain range. These ranges include:
- $11,670 to $46,680 for 1 person
- $15,730 to $62,920 for 2 people
- $19,790 to $79,160 for 3 people
- $23,850 to $95,400 for 4 people
- $27,910 to $111,640 for 5 people
- $31,970 to $127,880 for 6 people
You may qualify for lower premiums and lower out-of-pocket costs if your annual income falls within a certain range. These ranges include:
- $11,670 to $29,175 for 1 person
- $15,730 to $39,325 for 2 people
- $19,790 to $49,475 for 3 people
- $23,850 to $59,625 for 4 people
- $27,910 to $69,775 for 5 people
- $31,970 to $79,925 for 6 people
To learn more about Iowa’s Marketplace, visit www.iid.state.ia.us/Exchange.
To sign up for the exchange, visit healthcare.gov.
The 2016 annual open enrollment for Iowa starts November 1, 2015. If you miss the open enrollment period, you may be eligible to apply for insurance during a special enrollment period.
If you need assistance during your application process, you can submit a request for an enrollment specialist to contact you. Also, Iowa utilizes the federally run Navigator program to help consumers find the assistance they need.
Don’t let the open enrollment period pass you by without applying. Being insured is now law. If you don’t have health insurance, you may face fines and penalties. So no matter your current health or your previous experience trying to buy individual health insurance, you need to apply. That’s the only way you’ll ever know what you may be eligible to buy.