Iowa health insurance marketplace: history and
news of the state’s exchange

BCBS of Iowa and Bright Health offering plans for 2018; cost of CSR added to silver premiums,making other
metal levels particularly affordable

path ok

Louise Norris
Individual health insurance and health reform authority; broker
March 22, 2018

More Iowa coverage

  • path ok
    Insurance Guide
    • A guide to health insurance in
      your state.
  • path ok
    • Your state’s Medicaid expansion,
      eligibilty, contacts
  • path ok
    • Insurance for those over 64

Highlights and updates

  • 2018 enrollment down 4.6% from 2017
  • One insurer in 2017, but Bright Health joined in 2018
  • Average rate increase 15.6%, including added premiums to cover CSR cost
  • Cost of CSR added to silver exchange, other metal levels particularly cheap for some
  • 2018 rates and new insurer indicate death spiral no longer a danger

Iowa exchange overview

In 2018, 53,217 people enrolled in Medica, the only Affordable Care Act compliant insurer that offers individual healthcare plans in Iowa. This was a 3% increase from the previous year. However, most of Iowa’s insurers left the exchange in 2017. Due to this, there has been a sharp rate increase for Iowa’s individual market and unaffordable premiums.

On a brighter note, Wellmark and Farm Bureau intend to return in 2019 after Iowa enacted a state legislation allowing non-ACA-compliant plans back into the state. Furthermore, these plans will not be considered insurance and will not be regulated by the Iowa Insurance Division therefore appealing to only young, healthy residents. However, A Kaiser Family Foundation report estimated that 71% of Iowa’s non-elderly uninsured residents would qualify for Medicaid or subsidies to help with health coverage.


Health Ratings

Iowa was in the top ten in the 2017 Commonwealth Fund’s Scorecard on State Health System Performance—coming in at 6th. Its high ranks were due to its healthcare access, prevention and treatment and equity. Iowa ranked 1st place in number of adults who were without health care because of costs. According to the U.S. Census data, only four states had lower uninsured rates than Iowa did (Iowa’s uninsured rate was only 4.3%). However, in 2018 more than 20,000 residents left the individual insurance market because of high costing premiums for those who don’t get subsidies.

Rates and Carriers

Iowa had four carriers offering plans during the 2017 open enrollment. These four carriers were:

  • Aetna
  • Gunderson
  • Medica
  • Wellmark

However, for 2018, Aetna, Wellmark, and Gunderson stopped offering coverage to Iowa residents. The last one standing, Medica, had a rate increase of nearly 57% but with much larger premium subsidies and no assistance for those above 400% the poverty level.

The estimated market in Iowa for eligible residents enrolling in a qualified health plan is 224,000 people. However, only 29,000 people actually enrolled. That is 13% and to compare, the national average is 28%. For 2017, enrollment dropped 6%.

Iowa and Medicaid/CHIP

Iowa has accepted federal funding for Medicaid expansion which involved the Iowa Health and Wellness Plan in which households making below poverty level could enroll in the Iowa Marketplace Choice Plan and their premiums would often be paid by the government. 47% of Iwoa’s 301,000 non-elderly uninsured residents qualified for Medicaid or the Children’s Health Insurance Program (CHIP). From 2013 to 2017, Iowa’s Medicaid grew by 165,549 people which is a 32% increase.


Risks in Iowa

In 1987, the Iowa Comprehensive Health Association was established to give those with a pre-existing medical condition another option but after the Affordable Care Act was established, the association had seen a decrease of enrollees throughout the years. In 2013, the program had 3,002 members and only 391 as of September of 2016. It costs around $12 million to operate the Iowa Comprehensive Health Association in 2016.



In Iowa, 571,596 people are enrolled in Medicare. 86% qualify on age and the other 14% as a result of a disability. Annually, Medicare spends about $7,727 per person. Overall, Iowa ranks 32nd and spends $4.3 billion on Medicare. Like many other states, Iowa Medicare offers Advantage plans and 18% of Medicare recipients opt for an Advantage plan and 63% opt for Medicare Part D for prescription drugs.



Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.