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Iowa Health Insurance

Iowa Individual Health Insurance Market

There are many different individual health insurance policies that are offered in the state of Iowa and it is the consumer's responsibility to carefully review and compare different policies to determine which best fits their needs. Medical underwriting is allowed in Iowa. Medical underwriting is the process that allows health insurance companies to review the medical records of prospective members. There is a 12 month look back and exclusionary period limit for preexisting conditions for standardized guarantee-issue policies for those without prior health coverage. There is a 60 month look back and 12 month exclusionary period for other policies for those without prior health coverage.

There is a high risk pool in Iowa for the medically uninsurable called the Iowa Comprehensive Health Association. To be eligible for this pool, you must be a resident of Iowa, have been denied health coverage, have had a reduction in health benefits, or have received a notice of a premium increase that is higher than the pool rate. You may also be covered under the rights in HIPAA, if you have one of the conditions listed on the application, or are eligible under the federal Trade Adjustment Assistance Act of 2002.

High Risk Pool

Coverage under this high risk pool includes the following:

  • doctor visits
  • prescription drugs
  • outpatient and in-hospital care
  • maternity
  • ambulance
  • labs and x-rays
  • skilled nursing care
  • home health visits
  • transplants
  • rehabilitation
  • durable medical equipment
  • mental health and substance abuse
  • physical, speech and occupational therapy

Iowa Group Health Insurance (Small Business: 2-50 employees)

According to Iowa group health insurance policies, medical underwriting is allowed with a variance of plus or minus 25% of the indexed rate based on the health status of the group. For preexisting condition requirements, the carrier may look back in a consumer's medical history 6 months and impose a 12 month exclusionary period for those that did not have prior medical coverage.

For more information about group plans in Iowa, visit our Iowa Small Business group plan page.

Iowa COBRA Individual Health Coverage

Iowa offers COBRA (the Consolidate Omnibus Budget Reconciliation Act of 1985). Many small businesses with 20 or more employees that offer Iowa health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce.

Medicaid in Iowa

Medicaid is a program that pays for covered medical and health care costs of people who qualify. The Medicaid program is funded by federal and state governments and is managed by the Iowa Department of Human Services. Individuals seeking Medicaid in Iowa must meet certain income and other requirements.

Income requirements:

  • Children
    • Ages 1-5: 133% of the Federal Poverty Level
    • Ages 6-19: 133% of the Federal Poverty Level
  • Pregnant Women and Infants
    • Pregnant Women: 200% of the Federal Poverty Level
    • Infants - Ages 0-1: 200% of the Federal Poverty Level
  • Parents
    • Non-Working: 33% of the Federal Poverty Level
    • Working: 82% of the Federal Poverty Level

Other populations

Medically Needy Individual- 67% of the Federal Poverty Level

Medically Needy Couple- 50% of the Federal Poverty Level

Supplemental Security Income Recipients- 74% of the Federal Poverty Level

Covered Services

Outpatient, rural health clinic, Federally Qualified Health Centers, laboratory and x-ray, nursing home, physician services, early periodic screening diagnosis and treatment, family planning, clinic services, prescription drugs, case management, medical transportation, nurse-midwife services, extended services to pregnant women, and ambulatory prenatal care.

Co-Payments

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about Iowa Medicaid at http://www.dhs.state.ia.us/dhs2005/dhs_homepage/children_family/healthcare/medicaid.html

For information on Iowa Medicare, visit MedicareSolutions.com

Other Iowa Health Insurance Programs

Iowa offers the hawk-I program (Healthy and Well Kid of Iowa) for children under the age of 19 whose family income is up to 200%, who do not qualify for Medicaid, who live in Iowa, are U.S. citizens, have no other health insurance, and are not a dependent of a state of Iowa employee. Please visit the hawk-I website for more detailed information at http://www.hawk-i.org/.