Learning more about health insurance allows you to better choose a health insurance plan that fits both your health needs and your budget.    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.
 
Medicaid is available for certain people based on health conditions or income levels and has three programs for those receiving coverage: Iowa Medicaid’s managed care program called IA Health Link; those covered by Medicaid Fee for Service program; and those uninsured children of working families covered by the hawk-i program.
 
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 you are purchasing a policy that is on the federal Health Insurance Marketplace, you may receive help from a navigator, an assister, or an insurance agent certified to sell on the Health Insurance Marketplace.  There may be tax credits available to you depending on your income that can help reduce the cost of purchasing a plan on the Marketplace.  If you want to purchase a policy that is off the federal Health Insurance Marketplace, you can talk with an agent who is licensed to sell health insurance.  
 
The Iowa Comprehensive Health Association (HIPIOWA) may provide you access to health insurance coverage if you have certain medical conditions or are a federally eligible individual.
 
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.  Your employer may purchase the company’s small group health insurance plan either on or off the Health Insurance Marketplace.  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 you leave your job or are terminated, and are not eligible for Continuation of Health Coverage (COBRA) under federal law, you may be eligible for continuation of benefits under Iowa law or eligible for a special enrollment into an individual health plan through the federal Health Insurance Marketplace.
 
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 you leave your job or are terminated, you may be eligible for Continuation of Health Coverage (COBRA) under federal law or eligible for a special enrollment into an individual health plan through the federal Health Insurance Marketplace.
 
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.
 

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.   
 
If you are considering purchasing long-term care insurance, get free, confidential and unbiased help from our team at SHIIP. For more information about long-term care rate changes, view this report or browse its source data.  If an insurance company denied benefits because the policy’s benefit trigger was not met, you may file a request for an independent review.
 

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