Learning more about health insurance allows you to better choose a health insurance plan that fits both your health needs and your budget. It's important to also
review and compare the quality of care from hospitals and providers available under a health insurance policy. Health insurance is complicated, and there are many different options of coverage available from a variety of sources which are discussed in greater detail below. Be sure to read your policy for information about filing claims. If you already have health coverage and have questions, contact the carrier or
contact us.
Government-Sponsored Health Coverage (Medicare, Medicaid, TRICARE)
If you meet certain criteria, you may be eligible for government-sponsored health coverage.
Medicare is available to those age 65 and older as well as those with certain disabilities or diseases. Medicare recipients receiving traditional Medicare (Plans A and B) are eligible for
Medicare supplement insurance. The Iowa Insurance Division’s
Senior Health Insurance Information Program (SHIIP) offers free, confidential and unbiased resources to help Iowans make informed decisions on their Medicare and other health insurance coverage. For more information about Medicare Supplement rate changes, view
this report or browse
its data directly.
Active-duty service members, veterans and their families may be eligible for health benefits through the government. Visit the
U.S. Department of Veterans Affairs to find out about available options.
Individual Health Insurance
Individual health insurance is insurance you purchase yourself – not through an employer or provided through a government health insurance program. Individual health insurance policies come in two main forms –they are available either on or off the federal
Health Insurance Marketplace. Health plans compliant with the Affordable Care Act are based on
Essential Health Benefits (EHB) Benchmark Plans.
If an insurance company denied benefits because the services were not medically necessary, or because the services were investigational or experimental, you may be eligible to file a request for an
external review.
States with an 'Effective Rate Review Program' (which Iowa has been granted such status by CMS), must provide a link to the rate review information made available on the CMS website:
https://ratereview.healthcare.gov/
Small Group Health Insurance
Small group health insurance is provided by employers that have 1-50 employees. Currently in Iowa, small group health insurance is only available Off-Exchange. Small group employers can purchase small group health insurance plans directly from a health insurance carrier or with the assistance of an Iowa licensed insurance producer. Small group employers may self-insure by assuming the financial risk of paying claims incurred by employees. There will be no insurance companies underwriting the health plans, although sometimes they administer the plans. Health plans compliant with the Affordable Care Act are based on
Essential Health Benefits (EHB) Benchmark Plans.
Check with your employer to see which type of health insurance they offer. If the plan is
self-insured, questions or complaints should be directed to the
U.S. Department of Labor rather than the Iowa Insurance Division.
If an insurance company denied benefits because the services were not medically necessary, or because the services were investigational or experimental, you may be eligible to file a request for an
external review.
Large Group Health Insurance
Large group health insurance is provided by employers that have 51 or more employees.
Many large group health insurance plans are
self-insured and assume the financial risk of paying health plan claims incurred by employees.
Check with your employer to be sure which type of health insurance they offer. Any questions or complaints regarding
self-insured plans should be directed to the
U.S. Department of Labor rather than the Iowa Insurance Division.
If an insurance company denied benefits because the services were not medically necessary, or because the services were investigational or experimental, you may be eligible to file a request for an
external review.
Multiple Employer Welfare Arrangements (MEWAs) and Association Health Plans (AHPs)
A multiple employer welfare arrangement (MEWA) is an employee welfare benefit plan, or any other arrangement which is established or maintained for the purpose of offering or providing any benefit to employees of two or more employers as defined in section 3 of the federal Employee Retirement Income Security Act, 29 U.S.C. section 1002, paragraph 40. Association health plans (AHPs) are a type of MEWA. View
more information about MEWAs or AHPs here.
Short-Term Limited-Duration Health Insurance
The federal government extended the permissible period of time for short-term limited-duration health insurance policies to permit them to provide coverage for up to 364 days and for a period of 3 years. In 2019, the Iowa Insurance Division adopted administrative rules to provide meaningful minimum standards of benefits and enhanced consumer protections for short-term limited-duration policies. Some policies may cover pre-existing conditions, others may not; consumers should read the policy language carefully to make this determination.
The IID is reviewing carrier filings and has authorized the following companies to sell plans for up to 364 days. No other carriers are authorized to sell plans that have a duration of 364 days. Consumers looking for plans beyond 364 days should check to make sure the plan is renewable.
Long-term Care Insurance
Long-term care insurance may help cover some or all of the following services: help with daily activities for a person with health conditions, home health care, respite care, hospice care, adult day care, care in a nursing home, or care in an assisted living facility.
Insolvent Life and Health Insurers
“The Iowa Life & Health Insurance Guaranty Association is a statutory entity created in 1987 [by] the Iowa Legislature. . . . The Guaranty Association is composed of all insurers licensed to sell life insurance, accident and health insurance, and individual annuities in the state of Iowa. In the event that a member insurer is found to be insolvent and is ordered to be liquidated by a court, the Guaranty Association will provide protection [up to statutory limits] to Iowa residents who are holders of life and health insurance policies and individual annuities with the insolvent insurer.” -- Iowa Life & Health Insurance Guaranty Association.
For more information, go to the Iowa Life & Health Insurance Guaranty Association’s website.
Prior Authorization Forms
Each health carrier, health benefit plan, and pharmacy benefits manager is required to create, use, and submit a single prior authorization form to the commissioner for approval.
The prior authorization forms that have been approved by the Iowa Insurance Division can be found on this page.
Contact Us
Insurance can be complicated. The staff at the Iowa Insurance Division is here to help answer your questions or concerns regarding your health insurance needs. If you need assistance, please
contact the Iowa Insurance Division.