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.⁵
• If married, file a joint tax return.⁶
• Not be able to be claimed by someone else as a tax dependent.⁶

You can sign up for an ACA-compliant individual or family health insurance in Iowa between November 1 and January 15 during open enrollment.⁷ 

Here are some key dates to remember: 

• If you enroll by December 15, your coverage starts on January 1. 
• If you enroll between December 16 and January 15, your coverage begins on February 1. 

The enrollment window will be shorter, ending on December 15, starting in the fall of 2026. And all plans selected during open enrollment (for coverage effective in 2027 and future years) will take effect on January 1. The shorter open enrollment period is due to a federal rule that was finalized in 2025.

If you miss open enrollment, you may still get coverage through the Marketplace 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. 

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 2025 overage:⁹

• 88% of Iowa Marketplace enrollees qualified for premium subsidies.
• These premium subsidies (called Advance Premium Tax Credits or APTC) saved Iowa Marketplace enrollees about $470/month on average in 2025.
• Across all Iowa Marketplace enrollees, including the 12% who paid full price, average net premiums amounted to about $141/month. Among the 88% of enrollees who were subsidy-eligible, the average after-subsidy premium was $99/month.
  

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 2025, there were still nearly 21,000 people enrolled in these plans.⁴

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 2026, all of which also offered coverage in 2025:³

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

UnitedHealthcare and Iowa Total Care (Ambetter) were new for 2025,¹¹¹² bringing the number of participating insurers to five in Iowa’s Marketplace.¹³ And all five carriers will continue to offer coverage in 2026.

The following average rate changes have been proposed for 2026 by Iowa’s individual market insurers.¹⁴,⁴ (Average rate changes are calculated before subsidies are applied.)

Source: RateReview.HealthCare.gov,¹⁵ and Iowa Insurance Division⁴

Wellmark and Oscar, which proposed the smallest percentage rate increases for 2026, have the majority of the market share. So the weighted average proposed rate increase for 2026 amounts to about 14.5%, despite the much larger proposed increases from the other carriers.¹⁶

The average full-price rate change in Iowa is quite a bit smaller than the national average for 2026.¹⁷ 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. For 2026, subsidies will shrink and be available to fewer people, unless Congress extends the federal subsidy enhancements that have been in effect since 2021. If that happens, rates will increase significantly for everyone who receives subsidies.¹⁶

If the cost of your current plan increases, you can explore other health plans in the exchange that may be more affordable and offer similar benefits. 

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

During the open enrollment period for 2025 coverage, a new record high for Iowa’s exchange was reached, with 136,833 people signing up for private individual market plans.²⁹

This increase in enrollment in recent years (see graph below) was due partly to the American Rescue Plan (ARP) and Inflation Reduction Act, which have made Marketplace subsidies larger and more widely available through 2025. The 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 2025²⁹

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.