Iowa's individual health insurance market may be stabilizing, experts say

The annual sign-up period for individuals to sign up for health insurance is just around the corner and Iowa’s market is in a better place than it was in recent years, some experts say.

In the past, Iowa has dealt with an unstable insurance market. But since a major insurance company has rejoined the market and premiums are trending downward, Iowans won’t see much shift in their plans, insurance officials and researchers believe.

“We don’t expect anything different for the coming year,” said Scott Sundstrom, vice president of government relations at Wellmark Blue Cross and Blue Shield. “It looks like overall, markets are doing fairly well. They seem to be stabilizing, compared to two or three years ago when things weren’t looking as good.”

Even as Iowans have more options outside of the federal marketplace available to them now more than ever, insurance officials like Sundstrom and other national experts don’t foresee alternative health care plans will cause a major stir.

“I know there’s been a lot of discussion around those plans and on what the effect they’ll have but so far, I don’t think they’ve had a huge effect,” Sundstrom said.

Open enrollment for Iowans purchasing health insurance through the Affordable Care Act for 2020 kicks off on Friday and will end on Dec. 15. Individuals can buy into or change their individual insurance plan for an effective date of Jan. 1, 2020.

Medica and Wellmark are offering health insurance within the ACA marketplace for Iowans for the upcoming year, meaning every state county will have a choice of at least two carriers. Premiums under both of these companies are expected to be lower than this year.


Wellmark left Iowa’s exchange in 2018, leaving the state with only one carrier, Medica. However, Wellmark returned in 2019.

“Things have been better since (2018) because a major company has rejoined the marketplace and are still there now,” said Katherine Hempstead, senior adviser for the Robert Wood Johnson Foundation.

The Iowa Insurance Division estimates that more than 39,000 Iowans are in the individual market this year.

The total number of Iowans enrolling in these ACA-compliant plans has been on the decline since 2016, falling from nearly 75,000 to nearly 38,000 in 2018, according to data from the Iowa Insurance Division.

The state insurance division also estimates nearly 1.7 million Iowans rely on employer-based health insurance, which includes employees of large and small companies, government agencies and military.

More than 1.1 millions Iowans access health care through public programs such as Medicaid and Medicare, state data shows.

It will be 10 years since aspects of the Obama-era legislation started to go into effect, but a greater number of Iowans remain in grandfathered or transitional policies — which are not compliant with the ACA.

“The ACA-compliant insurance market is available to Iowans, however, many Iowans have been priced out of that market,” Iowa Insurance Commissioner Doug Ommen said in a statement. “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 2020.”


Grandfathered plans predate the ACA passage in 2010 and are allowed to exist under a provision of the law. Transition plans were sold up until 2014, the first year of the ACA, and also have been allowed to remain.

In 2018, the Iowa Insurance Division stated 31,997 people held grandfathered plans and 31,868 Iowans had transitional plans.

“The reality is, given the nature of what they are, they can’t sell new (grandfathered or transitional) plans,” Sundstrom said. “Those are inevitably shrinking numbers.”

Hempstead echoed this statement, but added that in the past that these plans have caused a more fragmented market in Iowa — an effect that may be lessening.

“I think (Iowa) still had a decent amount of trouble from those (non-compliant) plans in the past,” she said. “I’m sure those issues are winding down and are much less of a factor than it was in the past.”

In addition, state insurance officials have adopted federal guidelines that allow other health benefit plans, including short-term limited duration plans approved by the Iowa Insurance Division for 2020.

These plans, initially created to fill gaps between long-term insurance plans, are available 364-days a year and can be renewable for up to three years.

The Iowa Farm Bureau Federation also unveiled health benefit plans a year ago, available only to their association members on a year-round basis.


But just how many Iowans are taking advantage of this plan is unclear, as a spokesman for the Iowa Farm Bureau declined to share the group’s total enrollment.

“The three options under the Farm Bureau Health Plan all provide comprehensive coverage including maternity, mental health and chemical dependency, prescription drugs and no-cost preventive benefits to members,” said Iowa Farm Bureau Spokesman Andrew Wheeler in a statement to The Gazette. “The plans, administered by Wellmark, cover all Iowa hospitals and 97 percent of Iowa physicians, proving to be a cost-saving health plan option for those who currently don’t have one.”

But some national researchers called these plans “skimpy,” stating limited coverage options are poor proposals that “would do more harm than good” for farmers and farmworkers who lack health insurance coverage.

Officials encourage Iowans to talk with an insurance agent as they consider their options for health care coverage next year. Individuals can find local help by visiting the ACA website at

“Make sure you find the coverage that makes the most sense for your situation,” Sundstrom said.

Comments: (319) 368-8536;

Give us feedback

We value your trust and work hard to provide fair, accurate coverage. If you have found an error or omission in our reporting, tell us here.

Or if you have a story idea we should look into? Tell us here.

Want to join the conversation?

Consider subscribing to and participate in discussing the important issues to our community with other Gazette subscribers.

Already a Gazette or subscriber? Just login here with your account email and password.

Give us feedback

We value your trust and work hard to provide fair, accurate coverage. If you have found an error or omission in our reporting, tell us here.

Or if you have a story idea we should look into? Tell us here.