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Iowa health insurance exchange

Poor outlook for Iowa’s health co-op

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At the six-week mark of the 2015 open enrollment period, Iowa has already topped its 2014 open enrollment total. As of Jan. 9, 34,586 individuals had selected health plans through the marketplace. During all of 2014 open enrollment, fewer than 30,000 Iowans purchased coverage.

Open enrollment continues through Feb. 15. After that date, only people who qualify for a special enrollment period can purchase 2015 coverage.

 Co-op plan now under state control

Three insurers are participating in the Iowa marketplace in 2015: Avera Health Plans, Health, Coventry, and Gundersen Health Plan. These insurers participated in 2014 as well. Wellmark, the largest insurance carrier in Iowa, did not participate in the marketplace in 2014 and decided against joining the exchange for the 2015 plan year.

A fourth insurer, CoOportunity Health, had been participating in the marketplace, but stopped offering policies in late December 2014. CoOportunity was a start-up health insurer formed with funding through the Affordable Care Act. The insurer got into financial difficulty after higher than expected enrollment and claim costs in 2014.

Nick Gerhart, the Iowa insurance commissioner, now has oversight of CoOportunity. Gerhart says while his staff is still evaluating whether to restructure or liquidate the insurer, the outlook is “tough.”

Consumers who signed up with CoOportunity on or before Dec. 15 have coverage as long as they pay their premiums. However, consumers who signed up with CoOportunity on or after Dec. 16 or are not covered. Gerhart recommends that anyone covered by CoOportunity move to a different insurance company before open enrollment ends on Feb.15.

With CoOportunity’s withdrawal, Coventry is the only marketplace insurer available in all counties.

Premiums up 11 percent on average

A study by The Commonwealth Fund shows that 2015 marketplace premiums in Iowa are up 11 percent on average compared to 2014. The Commonwealth Fund’s study was weighted for differences in premiums between urban/suburban/ rural areas and insurer participation.

2014 enrollment metrics

In total, 29,163 people enrolled in qualified health plans (QHPs) during 2014 open enrollment, and an additional 36,891 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP).

Just 11.1 percent of Iowa residents eligible to enroll through the marketplace did so in 2014. Iowa tied with neighboring South Dakota for the lowest percentage of eligible enrollees signing up. A Kaiser Health News article attributes the low enrollment in both states to Wellmark Blue Cross & Blue Shield’s decision against participating in the states’ marketplaces rather than a boycott of the Affordable Care Act.

A U.S. Department of Health and Human Services report showed the average, post-subsidy premium for Iowa consumers was $108 per month. The national average in states using $82 per month after subsidies.

Twenty-six percent of Iowa residents selected a bronze plan (20 percent nationally), 57 percent selected a silver plan (65 percent nationally), 12 percent selected a gold plan (9 percent nationally), 4 percent selected a platinum plan (5 percent nationally) and 2 percent selected a catastrophic plan (2 percent nationally). Twenty-six percent of Iowa enrollees were between the ages of 18 and 34.

Iowa’s approach to the marketplace

Iowa operates a partnership exchange with the federal government. Iowa residents use the federal marketplace,, to compare and purchase coverage. The state is responsible for plan management, consumer assistance, and Medicaid eligibility determination. Iowa’s plan management functions include selecting and monitoring the qualified health plans (QHP) that offer policies on the exchange. Iowa’s role in consumer assistance is education and outreach, coordinating the in-person consumer assisters, and overseeing the Navigator program. The federal government manages the exchange website and call center, and funds the Navigator program.

Iowa is occasionally mentioned as a state that may transition to a different model for its exchange. In February 2014, Gov. Branstad floated the idea of a regional exchange in conjunction with South Dakota, Nebraska and Kansas. Bills to convert to a state-run exchange were introduced in Senate committees in both 2013 and 2014, but neither advanced.

Iowa health insurance exchange links

Iowa Insurance Division: State Partnership Exchange Plan Management

State Exchange Profile: Iowa
The Henry J. Kaiser Family Foundation overview of Iowa’s progress toward creating a state health insurance exchange.

Consumer Advocate Bureau
Provides consumers with assistance in navigating the health care system, assistance programs, and other issues related to health insurance benefits.
1-877-955-1212 /