Des Moines – Open enrollment begins November 1 and ends December 15 for Iowans purchasing or changing their Affordable Care Act (ACA) individual health coverage to become effective January 1, 2019.
“As the open enrollment season begins, Iowans should thoroughly research all coverage options. The ACA-compliant insurance market is available to Iowans, however, most Iowans have been priced out of that market if they are not currently receiving federal subsidies to help pay premiums and, in some instances, deductibles. I would encourage consumers to meet with a licensed insurance agent to determine the best plan for themselves and their families,” Iowa Insurance Commissioner Doug Ommen said. “Changes made at the Iowa state legislature and by the federal government have provided a few more options in addition to ACA-compliant coverage for Iowans to review as they plan out their health needs for 2019.”
Iowans can begin previewing sample premium amounts for individual ACA-compliant health insurance plans at https://data.iowa.gov/Health/Sample-2019-Iowa-Individual-Affordable-Care-Act-Co/smvn-ctjb/data for each of Iowa’s seven rating areas*. These premium amounts will become official once posted to healthcare.gov during open enrollment beginning November 1, 2018.
Iowans that wish to purchase ACA-compliant coverage need to complete enrollment between November 1 and December 15, 2018 to have coverage effective by January 1, 2019. During open enrollment, Iowans may call 1-800-318-2596 or visit healthcare.gov for information regarding enrollment and to calculate applicable tax credits. Healthcare.gov is the only official government website selling health insurance, and buyers should beware of imitation websites.
Local insurance agents, assisters, and certified application counselors around the state are available to help Iowans review which insurance plan may best fit their needs. Iowans can find local help by visiting https://localhelp.HealthCare.gov/.
Most Iowans access healthcare in one of three ways:
- Employer-Sponsored: It is estimated that 1.6 million Iowans participate in employer-based health insurance plans. This includes employees of large and small private companies, federal, state and local government employees and active military. Consumers in a small business should talk to a licensed insurance agent to discuss all available coverage options.
- Public Programs: Roughly 1.2 million Iowans receive healthcare benefits through Medicare and Medicaid.
- Individually-Purchased: In 2018, approximately 107,000 Iowans purchased health insurance on their own. About 39,000 Iowans remain in the individual ACA-compliant market. An additional 68,000 continued coverage in a grandfathered or transitional policy.
Under each category, there are important developments and information consumers should keep in mind as open enrollment begins:
Individually-Purchased Health Insurance or Health Plans
- The 2019 ACA-compliant open enrollment period is Nov. 1 through Dec. 15, 2018. Coverage begins Jan. 1, 2019. Consumers can begin researching options now at https://data.iowa.gov/Health/Sample-2019-Iowa-Individual-Affordable-Care-Act-Co/smvn-ctjb/data.
- Medica and Wellmark will be offering ACA-compliant individual health insurance plans to Iowans statewide for plan year 2019.
- If you currently have coverage through the exchange and do not choose a plan for 2019 by the end of open enrollment, you will be re-enrolled into the same plan offered by Medica.
- Changes in federal and state regulation are opening options for Iowans to find health coverage through a Multiple Employer Welfare Arrangement (MEWA), an Association Health Plan (AHP), or a health benefit plan sponsored by a non-profit agricultural organization.
Employer-Sponsored Health Insurance
- If you’re already covered by an employer-sponsored plan, pay close attention to your enrollment options this year. Premiums and coverage limits may have changed.
- If you are changing jobs, you may be subject to a probationary period, up to 90 days, during which you are not eligible for group coverage.
- If you lost coverage from a previous employer, you typically have 60 days to enroll in private individual insurance through healthcare.gov under a Special Enrollment Period. If you have recently lost a job and access to employer-based insurance, you and your dependents may be eligible for continuation coverage under COBRA.
- Consumers in a small business should talk to a licensed insurance agent to discuss all available coverage options.
Public Healthcare Programs
- Medicare is a federally funded program available to most U.S. citizens and permanent legal residents age 65 or older who have lived continuously in the country for at least five years. People younger than 65 also may be eligible for Medicare if they are disabled, suffer from kidney failure or ALS (Lou Gehrig's disease). If you have questions about enrolling in Medicare, you can contact Iowa’s Senior Health Insurance Information Program at http://shiip.iowa.gov or call 1-800-351-4664.
- Medicare open enrollment for Medicare Advantage and Medicare Prescription Drug coverage (Part D) takes place from Oct. 15 through Dec. 7, 2018. If you miss the deadline and didn’t experience a qualifying event, you can apply during general enrollment (Jan. 1 through March 31 of each year), though you will have to pay a premium penalty.
- Medicaid is jointly funded by federal and state governments. Eligibility is means-based with state-based income requirements. To see if you and your family are eligible for Medicaid, please visit the Iowa Department of Human Services at dhsservices.iowa.gov or call 1-855-889-7985.
*This sample preview dataset is NOT a substitute for healthcare.gov. This dataset does not generate tax credits that you may eligible for and it is only a rating area summary of premiums as opposed to a county summary of premiums as in the case of healthcare.gov. Consequently, a plan premium that you are previewing in this dataset may not be available in the county in which you reside. This is for window-shopping only.