With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make healthcare insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Iowa, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Iowa
Iowa placed 24th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include a low rate of drug deaths, a high rate of high school graduation, and high immunization coverage among children. Iowa’s challenges include a high prevalence of binge drinking, a high incidence of infectious disease, and limited availability of primary care physicians. In the past year, physical activity among the state’s residents increased; however, so did smoking and pertussis.
The U.S. Department of Health and Human Services reported that 29,163 individuals in Iowa selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Iowa enrolled in a marketplace plan increased to 45,162 during the open enrollment period.3
Iowa individual and family health insurance
Iowa is among the few states whose Obamacare health insurance exchange operates as a state-federal partnership. The state assumes plan management functions and performs Medicaid and CHIP eligibility determinations.8 Iowa residents shop for health insurance plans and enroll in coverage through the federal marketplace.
Those who buy health insurance through the federal marketplace may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Iowans may also find qualified health plans away from the Obamacare exchanges in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Iowa’s Health Insurance Exchange to apply for a health insurance plan.
|Iowa’s health insurance exchange:||healthcare.gov|
|Iowa’s department of insurance:||iid.state.ia.us|
Iowa small group health insurance plans
Small business owners who live in Iowa and have 50 or fewer employees may offer them access to coverage through the federal Health Insurance Marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Iowa’s partnership exchange.
Iowa state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Iowa’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||2 to 19|
|Maximum continuation period – standard||9 months|
|Maximum premium Increase||100 percent|
|State legislation reference||Iowa Code Chapter 509B|
|More Information||877-955-1212 — Iowa Insurance Division Helpline|
|Additional notes||To be eligible, you must be covered under the group health plan for 3 months prior to a qualifying event|
Iowa high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Iowa is among the states that expanded Medicaid.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Iowa’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Iowa Department of Human Services|
|How to apply online||dhsservices.iowa.gov/apspssp/ssp.portal / healthcare.gov|
|Additional application options||dhs.iowa.gov/how-to-apply|
|Phone number||800-972-2017 / 800-735-2942 TTY|
|Open-enrollment period||Year-round in all states|
|Eligibility||Connecticut residents 19 to 65 with qualifying annual income levels and do not qualify HUSKY A, do not receive Medicare and are not pregnant may qualify for HUSKY D, which was expanded under the Affordable Care Act.|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Iowa’s health insurance program for low-income children:
|Where to apply||hawk-i.org/en_US/apply.html|
|Phone number||800-257-8563 / 888-422-2319 TTY|
|Eligibility8||To qualify, a child must be under age 19 and live in Iowa, be a U.S. citizen or qualified non-citizen, meet family income limits; dependents of State of Iowa employees and children who qualify for Medicaid cannot get hawk-i|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Iowa Insurance Division Consumer Advocate. “A Consumer Guide to Continuation of Group Health Insurance Coverage.” Last updated June 4, 2012. http://insuranceca.iowa.gov/health/continuationofgrouphealthinsurancecoverageconsumerguide.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Iowa.” http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/iowa.html.
8 hawk-i. “Does My Child Qualify for hawk-i?” http://www.hawk-i.org/en_US/qualify.html.