ACA open enrollment begins Saturday, November 1, despite continued disagreements in Congress over funding for the Affordable Care Act (ACA) healthcare subsidies and other matters that are contributing to the ongoing federal government shutdown.
“The temporarily enhanced federal subsidies Congress passed in 2021 and 2022 have only masked the underlying problems that have existed in the Affordable Care Act since its creation and Americans will see that cost as the ACA open enrollment period begins on November 1. Congress needs to finally address the structural flaws that have plagued the ACA from the beginning and made these premiums so unaffordable,” said Iowa Insurance Commissioner Doug Ommen. “Money alone won’t fix this. We’ve spent hundreds of billions nationally to paper over the ACA’s flaws, but the design itself is broken. Without reform, the ACA will fail the very people it was supposed to help — farmers, small business owners, and early retirees who need affordable options in the individual market.”
The federal subsidies, otherwise known as advanced premium tax credits or APTCs, for Iowans accessing health insurance through the ACA have gone from $189 million in 2017 to over $630 million in 2025. In 2025 the estimated $630 million in taxpayer subsidies went to fewer than 112,000 Iowans.
The ACA’s Structural Flaws:
- Federal subsidies (APTCs) are based only on income. This ignores age and actual health risk, which distorts the market and makes premiums more expensive.
- The federal subsidy cliff at 400% of Federal Poverty Level (FPL). A single dollar of additional income can cause families to lose all financial assistance. This is extremely problematic as Iowans estimate what they expect their income for the year to be before the year starts. This not only creates a disincentive for families to earn more during the upcoming year but can also force them to repay thousands of dollars in premium tax credits if their income unexpectedly increases.
- Flawed age-banding. Age banding sets limits on how much more older adults can be charged compared to younger adults. The ACA requires a 3:1 ratio, rather than the more actuarially sound 5:1 ratio.
For example, if a younger Iowan’s full premium is $200 under the ACA’s 3:1 structure, the premium for an older Iowan cannot exceed $600. Enhanced APTCs have further distorted this balance. Because subsidies cap consumer contributions at a percentage of income, the practical effect has often been to flatten premiums across ages — making the ratio closer to 1:1 in reality.
This ignores the very real differences in health risks between younger and older populations. The result is predictable: younger, healthier Iowans exit the market, while older, higher-risk enrollees remain — worsening the overall risk pool and making coverage more expensive.
"These structural flaws are not minor glitches — they go to the heart of how this law functions. Only Congress can fix them, but there has to be an actual desire to fix what is broken,” Ommen said. “ Arguments in Congress over the level of subsidies only mask the underlying problems leading to these premiums being so unaffordable. Iowans need the individual health insurance market to work. It serves a necessary purpose. But it must be repaired.”
Open Enrollment Period
Open enrollment for Iowans looking to purchase or change their ACA individual health coverage for 2026 begins Saturday, November 1, 2025, and ends on Thursday, January 15, 2026.
“Now is the time for Iowans to be thinking about health insurance coverage for next year,” Commissioner Ommen said. “Many employers are offering health insurance coverage to their employees, but Iowans looking to purchase their own coverage through the individual market need to assess their upcoming health care needs now as open enrollment begins through healthcare.gov - especially given the changes at the federal level in the amounts of federal subsidies provided and who can receive them."
Why Premiums Are Rising
Carriers have filed 2026 rate increases ranging from 12.6% to more than 25%. This is reflective of the changes to the enhanced subsidies under the federal American Rescue Plan Act (ARPA) and the Inflation Reduction Act (IRA), medical inflation and increased utilization. In 2026, the APTCs levels will also revert to the levels originally available under the ACA, resulting in increased premium levels for those who are eligible for APTCs and making subsidies unavailable for those who have income at or above 400% of FPL.
For example, a family of four with two 28-year-old adults and two 4-year-old children making $63,978.50 (199% of FPL):
- In 2025, the family of four would pay a max of 1.96% of their income which equals $101.41 monthly.
- In 2026, the family of four would pay a maximum of 6.47% of their income which equals $344.95 monthly.
For another example, a couple, both age 55, making $95,175 (450% of FPL):
- In 2025, the couple would pay a maximum of 8.5% of their income which equals $651.53 monthly.
- In 2026, the couple would pay the whole premium without APTCs which equals $1,658.80 monthly.
Ommen warned that the ACAs structural flaws will once again push healthier Iowans out of the ACA market as the price paid is no longer reflective of their health risk, leaving behind a sicker, more expensive risk pool. “We saw this movie before in 2017 and 2018 when the market nearly collapsed. Without reform, we risk déjà vu all over again.”
Insurers Providing ACA-compliant Coverage to Iowans
Six insurers will offer ACA-compliant individual plans in Iowa for 2026 through healthcare.gov: Avera Health Plans, Iowa Total Care (AmBetter), Medica, Oscar, UnitedHealthcare Plan of the River Valley, and Wellmark Health Plan of Iowa.
- Medica: All 99 counties.
- Wellmark Health Plan of Iowa: All 99 counties.
- Avera Health Plans – 7 counties: Clay, Dickinson, Emmet, Lyon, O’Brien, Osceola, Sioux.
- Iowa Total Care – 58 counties: Adair, Appanoose, Audubon, Benton, Boone, Buchanan, Butler, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clinton, Crawford, Davis, Decatur, Dubuque, Fayette, Floyd, Franklin, Fremont, Hancock, Hardin, Henry, Ida, Jackson, Jasper, Jefferson, Keokuk, Kossuth, Lee, Linn, Louisa, Madison, Mahaska, Marion, Mills, Monona, Monroe, Montgomery, Page, Palo Alto, Polk, Pottawattamie, Ringgold, Scott, Shelby, Sioux, Tama, Taylor, Union, Van Buren, Warren, Washington, Wayne, Winnebago, Woodbury, Worth.
- Oscar – 75 counties: Adair, Adams, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clayton, Clinton, Dallas, Decatur, Delaware, Dubuque, Fayette, Floyd, Franklin, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Howard, Humboldt, Ida, Iowa, Jackson, Jasper, Jefferson, Jones, Keokuk, Kossuth, Lucas, Madison, Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Palo Alto, Plymouth, Polk, Pottawattamie, Poweshiek, Ringgold, Sac, Scott, Shelby, Sioux, Tama, Union, Van Buren, Wapello, Warren, Wayne, Winnebago, Woodbury, Worth, Wright.
- UnitedHealthcare Plan of the River Valley – 17 counties: Adair, Adams, Audubon, Cass, Clarke, Decatur, Fremont, Guthrie, Harrison, Mills, Montgomery, Page, Pottawattamie, Ringgold, Shelby, Taylor, Union.
Enrollment Details
Iowans may preview sample 2026 premiums using the Iowa Individual ACA Premiums Explorer, though actual rates and subsidy calculations will be finalized on healthcare.gov starting November 1.
Enrollment between Nov. 1 – Dec. 15 starts coverage on January 1, 2026.
Enrollment between Dec. 16 – Jan. 15 starts coverage on February 1, 2026.
Iowans with a current ACA policy who do not actively select a plan will be automatically re-enrolled in their existing plan or a similar one.
Iowans considering changing insurance carriers should double-check to ensure your preferred healthcare provider(s) are in-network and your prescription drugs will continue to be covered.
Where Can I Get Help Deciding?
Local insurance agents, assisters and Iowa’s navigators are available to help Iowans review which insurance plan may best fit their needs. Iowans can find local help by visiting https://www.healthcare.gov/find-assistance/.
Given the ACA’s structural flaws with federal subsidies provided solely based on income and the subsidy cliff at 400% FPL, Iowans may want to include their accountant(s) or other type of financial planner(s) in discussions when making their health coverage choice.
Other Coverage Options
Iowans should also consider whether employer coverage, short-term limited duration plans (STLD), Farm Bureau plans, direct primary care arrangements, or other non-ACA options better fit their needs. Licensed insurance agents and navigators are available to help consumers weigh their choices at https://www.healthcare.gov/find-assistance/.
- For individuals purchasing their own health coverage
- Short-term Limited Duration Plans.
- Recent federal changes to the enforcement of short-term limited duration plans allow the sale of these plans for up to three years in duration consistent with Iowa regulations. See Bulletin 25-05 for more information.
- Limited Benefit Plans which cover specific medical conditions or procedures and only provide a limited amount of reimbursement.
- Non-insurance health coverage options that include:
- A health benefit plan sponsored by a non-profit agricultural organization such as the Farm Bureau Health Plan.
- Direct Primary Care which can provide certain health coverages in exchange for monthly or yearly fees to providers.
- Health Care Sharing Ministries in which members contribute monthly to cover the healthcare expenses of other members based on shared religious or ethical beliefs but there is no guarantee claims will be paid.
- For those who are looking to get health coverage through their employer.
- Nearly half of all Iowans receive coverage through their employer. Check with your employer to see if health insurance coverage is available to employees.
- If you leave your job or are terminated you may be eligible for Continuation of Health Coverage (COBRA) under federal law.
- Multiple Employer Welfare Arrangements (MEWAs) are 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. Iowans can view more information about MEWAs at: https://iid.iowa.gov/regulated-entities/regulated-benefit-plans/mewas-ahps
- For those looking to utilize government health coverage
- Certain Iowans are likely eligible for Medicare and should contact SHIIP to help get enrolled in Medicare during the Annual Enrollment Period (AEP) for Medicare which runs from October 15 to December 7 if they are:
- 65 years of age and older.
- Disabled and receive Social Security or Railroad Retiree disability benefits for 24 consecutive months.
- Have a diagnosis of ALS or Lou Gehrig’s Disease.
- Have a diagnosis of end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).
- Certain Iowans may be eligible for Medicaid 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.
- Iowa’s Medicaid Fee for Service program.
- Iowa’s Hawk-I Program for those uninsured children of working families.
- Active-duty service members, veterans and their families may be eligible for health benefits through the federal government. Visit the U.S. Department of Veterans Affairs to find out about available options.
The Iowa Insurance Division is also warning consumers to be wary of health insurance fraud.
“Insurance is complicated, especially with all of the changes happening in the ACA market,” Ommen said. “Scammers often attempt to take advantage of folks when there are changes in law or how consumers can purchase insurance coverage. It’s important for Iowans that need health coverage to talk with a licensed insurance agent to make sure the coverage fits the individual needs of that consumer and their family.”