Iowa health insurance Marketplace guide

Anyone who meets the following criteria can buy Marketplace health coverage in Iowa:

• You must live in Iowa
• You must be a U.S. citizen, national, or lawfully present
• You must not be incarcerated
• You must not be enrolled in Medicare
  

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) is based on your income. Moreover, to qualify for financial assistance with your Marketplace plan, you must:

• Not have access to affordable health coverage through an employer. If your employer offers coverage, but you feel it’s too expensive, use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not qualify for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁴
• If married, file a joint tax return.⁵
• Not be able to be claimed by someone else as a tax dependent.⁵

The open enrollment period for 2026 ACA-compliant individual and family health insurance ended on January 15, 2026 in Iowa.⁶ 

The open enrollment period for 2027 coverage might be shorter, ending on December 15. But in June 2026, a judge vacated the federal rule change mandating the shorter open enrollment period.⁷

HHS could appeal the judge’s ruling, or may simply continue to use the open enrollment schedule that was used for the past several years, with a January 15 end date. Iowa Marketplace enrollees should pay close attention to any communications they receive from the Marketplace regarding deadlines for 2027 coverage.

Outside of the open enrollment period, you can only enroll or switch to a different individual market plan if you have a qualifying life event. Examples of qualifying life events include loss of health coverage, gaining a dependent, or permanent relocation (assuming you already had coverage prior to the move).  Native Americans can enroll year-round without a specific qualifying life event. 

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

You can enroll in an Iowa health insurance Marketplace plan by:

• Visiting HealthCare.gov
• Calling 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.
  

You can also find local help from local insurance agents, brokers, certified application counselors or an approved enhanced direct enrollment entity.⁸ They can review options and help you pick a plan to fit your needs. Find local help at localhelp.HealthCare.gov

You can find affordable health plans in Iowa on the ACA Marketplace (HealthCare.gov).

During the open enrollment period for 2026 overage:⁹

• 76% of Iowa Marketplace enrollees qualified for premium subsidies.
• These premium subsidies (called Advance Premium Tax Credits or APTC) saved Iowa Marketplace enrollees about $499/month on average in 2026.
• Across all Iowa Marketplace enrollees, including the 12% who paid full price, average net premiums amounted to about $235/month. Among enrollees who qualified for a premium subsidy, the average net premium was about $134/month.
  

Marketplace subsidies are still available in 2026, but they don’t cover as much of enrollees’ total premiums as they did in 2025. And subsidies are no longer available to applicants with total household income above 400% of the federal poverty level.

Source: CMS.gov⁹

In addition to APTC, if your household income isn’t more than 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR). CSRs help reduce deductibles and out-of-pocket expenses. Note that you must select a Silver-level plan to take advantage of CSR benefits.

Depending on your household income, you may qualify for Iowa Medicaid instead of Marketplace subsidies. 

As of 2023, there were still nearly 30,000 people in Iowa who were enrolled in individual grandfathered or grandmothered health plans.¹⁰ By 2026, there were still nearly 18,000 people enrolled in these plans.¹

These pre-ACA plans do not have to comply with various aspects of the ACA, and people enrolled in these plans cannot get the financial assistance that’s available via the Iowa Health Insurance Marketplace. If you’re enrolled in a pre-2014 health plan, it’s important to double-check your options in the Iowa Marketplace during open enrollment, to see if a newer plan might provide better coverage and/or lower premiums.

In Iowa, five companies will offer plans through the exchange for 2027:¹

• Oscar Insurance Company
• Wellmark Health Plan of Iowa, Inc
• UnitedHealthcare
• Iowa Total Care (Ambetter)
• Avera Health Plans

Six carriers offered exchange plans in Iowa for 2026, but Medica is exiting the individual market in Iowa at the end of 2026. Roughly 4,000 Iowa enrollees will need to select replacement coverage for 2027, due to Medica’s exit.¹¹

Iowa’s Marketplace insurer participation has changed a bit in recent years. Avera Health Plans was new for 2026.¹² And UnitedHealthcare and Iowa Total Care (Ambetter) were new for 2025.¹³¹⁴ 

The following average rate changes have been proposed for 2027 by Iowa’s individual market insurers.¹ (Average rate changes are calculated before subsidies are applied.)

Source: Iowa Insurance Division¹

Since Wellmark has the large majority of the market share, the overall weighted average rate increase is fairly close to Wellmark’s average, at about 6.7%, before any subsidies are applied.¹ This is quite a bit lower than the averages we’re seeing in other states for 2027.

The average full-price rate change in Iowa was also smaller than the national average for 2026.¹⁵

But most Iowa exchange enrollees receive premium tax credits and thus don’t pay the full premium amount themselves. If you qualify for subsidies, your actual rate change will also depend on how much your subsidy amount changes. Starting in 2026, subsidies cover a smaller share of enrollees’ total premiums (compared with 2021-2025), and they are available to fewer people. Because Congress failed to extend the federal subsidy enhancements, rates increased significantly for most enrollees.¹⁶

To show the magnitude of these rate increases, here are some examples of the sort of net premium increases that people saw in Iowa City for 2026:¹⁷

• 40-year-old earning $40,000:
  • Lowest-cost plan in 2025 was $33/month
  • Lowest-cost plan in 2026 is $152/month
• 60-year-old earning $63,000:
  • Lowest-cost plan in 2025 was $189/month
  • Lowest-cost plan in 2026 is $748/month (due to the subsidy cliff)

For perspective, here’s a summary of how full-price (unsubsidized) average premiums have changed in Iowa’s individual/family health insurance market over the years:

• 2015: Average increase of 11%.¹⁸
• 2016: Average increase of 22.3%.¹⁹
• 2017: Average increase of 28.8%.²⁰
• 2018: Average increase of 51%.²¹
• 2019: Average decrease of 7.9%.²²
• 2020: Average decrease of 10.8%.²³
• 2021: Average decrease of 0.2%.²⁴
• 2022: Average increase of 6.6%.²⁵
• 2023: Average increase of 2.3%.²⁶
• 2024: Average decrease of 5.5%²⁷
• 2025: Average decrease of 3.1%²⁸
• 2026: Average increase of 15.3%¹⁶,²⁹

123,304 people selected individual market coverage through the Iowa exchange during the open enrollment period for 2026 coverage,⁹ which was a reduction from the record-high enrollment Iowa’s exchange had in 2025.

The drop in enrollment for 2026 was due primarily to the fact that Congress did not extend the federal subsidy enhancements that expired at the end of 2025.

The increase in enrollment for the past several years before that (see graph below) was due in large part to the existence of those subsidy enhancements, which were created by the American Rescue Plan (ARP) and extended through 2025 by the Inflation Reduction Act.

The enrollment increase was also partly due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule, as Medicaid disenrollments resumed in the spring of 2023, after a three-year pause. As a result, some people who were previously enrolled in Medicaid transitioned to a Marketplace plan instead.

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023, ³⁹ 2024,⁴⁰ 2025⁴¹ 2026⁹

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

Iowa Insurance Division
Get information about insurance and other products regulated by the Iowa Insurance Division (IID). You can also file complaints about insurance with the IID.

Iowa Senior Health Insurance Information Program (SHIIP)
Helps answer questions and provide help to Medicare beneficiaries.