Iowa has seen much change over the decade since the Affordable Care Act passed. As the cost of health care continues to skyrocket, health insurance has become more valuable than ever.
But many families are having a tough time finding affordable coverage that doesn’t break the budget. It may take a little work, but you can find the right low-cost health insurance plan for you and your family.
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The Best Health Insurance in Iowa
What is Health Insurance?
Health insurance is a contract between you and an insurance company that pays for part or all of your medical costs for a premium. You pay this premium monthly to keep coverage. When you see the doctor for routine checkups or an emergency visit, the health insurance provider covers your expenses.
You can expect to pay your deductible before the health insurance company covers your costs. A deductible is a fixed amount that you must pay before the insurance takes care of the rest. Once you’ve reached your deductible, you’re only then responsible for the coinsurance cost on most plans.
If the insurer covered 90% of a $1,000 procedure, for example, you’d pick up the remaining $100. The general principle that works across insurance is the higher your deductible, the lower your premium, and vice versa.
Average Cost of Health Insurance in Iowa
The average private health insurance individual plan starts around $335 per month. And the average family plan starts at $1,184 per month. But your specific amount may vary because of several factors, including your family size, plan and location.
Types of Health Coverage
You can choose from a few kinds of health insurance plans. Knowing the difference among plan types can help you pick the best provider for your needs. A good rule to help you understand the pricing difference is the more freedom or choice, the higher the cost. Here’s a quick summary of the 3 most common types of insurance plans in Iowa:
- Health maintenance organization (HMO) plan: HMO plans require you to pick your doctor among those who have a contract with the insurance company. Your primary care doctor must refer you before you can see a specialist. HMO plans rarely cover out-of-network care except in an emergency. The plan may require you to live or work in a specific area to be eligible for coverage. HMO plans are often cost-competitive and require the least amount of paperwork.
- Preferred provider organization (PPO) plan: Like HMO plans, PPO plans offer a network of preferred doctors in the insurer’s network. PPOs differ by providing more freedom and allow you to choose providers outside of your plan’s network. But you’ll pay an added cost when you go outside the network. PPO plans offer more options than HMO plans, and you’ll often spend more for this openness.
- High deductible health plan (HDHP) with or without a health savings account (HSA): It’s a high deductible plan that seeks to give you a low premium. You can choose this plan type on an HMO or PPO plan. The HSA lets you pay for care and eligible medical expenses with tax-free money.
Not every health insurance company offers every kind of plan. Some providers feature only 1 plan type, while others offer all 3. You’ll want to talk to your plan’s representative and make sure you understand the structure before you set up your plan.
What Does Health Insurance Cover?
The Affordable Care Act (ACA) changed the structure of health insurance plans. It standardized the industry, and now every permanent insurance plan must have 10 “essential benefits.” Here are the benefits:
- Ambulatory patient services: This is outpatient care you get without admittance to a hospital.
- Emergency services: Your health insurance provider must cover visits to the emergency room regardless of whether a hospital is in-network. The insurance company can’t charge you more for getting emergency care from an out-of-network hospital.
- Hospitalization: The plan must cover overnight stays and surgeries.
- Pregnancy, maternity and newborn care: Pregnant women receive care both before and after birth. Plans must include newborn care.
- Mental health and substance use treatments: The health insurance provider must include behavioral health treatment, counseling and psychotherapy.
- Prescription drugs: The plan covers the cost of specific prescriptions. Each insurer has an approved list of medications. If there’s a particular drug that you need to be covered, you can check with the insurance company before signing up.
- Rehabilitative and habilitative services and devices: People with injuries, disabilities or chronic conditions can use these services and devices to gain or recover physical and mental skills.
- Laboratory services: This is coverage for tests such as bloodwork or urinalysis.
- Preventive and wellness services: The health insurance provider covers services such as vaccinations, boosters or diabetes screening.
- Pediatric services: The plan covers dental and vision care for children, but there’s no requirement for adults. You may buy dental or vision coverage as a supplement to your health insurance plan.
These 10 services make up the core of what every ACA-compliant plan must offer. Just remember that these minimum standards do not apply to short-term health insurance plans.
What Does Health Insurance Not Cover?
- Dental, vision and hearing coverage: The ACA requires this coverage for children. But adults will have to buy a separate plan.
- Weight loss surgery: Is someone in your family considering bariatric surgery? It’s rarely covered. Consult with the insurance provider before you enroll.
- Cosmetic surgery: Insurance companies do not supply coverage for procedures that are not medically necessary. You’ll receive no coverage for liposuction, injectables or augmentations. The exception would be for a medical reason, like fixing a child’s birth defect.
- Travel vaccinations: The insurance provider will only pay for vaccines that are considered medically necessary. That means vaccines needed for international travel are often not covered.
Those listed here are a few common examples of things most health insurance plans don’t cover. Normally all procedures must be medically necessary and related to an ACA essential benefit. There is an appeal process. Consult your health insurance company for more information on specific treatments or therapies.
Best Health Insurance Providers in Iowa
Now that you have a good grasp on how health insurance works in Iowa, here’s a quick summary of the best health insurance plans with affordable rates:
Medica grants access to a vast network of physicians, clinics and hospitals through Iowa, Nebraska and parts of bordering states. Medica boasts over 8,290 doctors, 55 clinics and 133 hospitals in its network.
Check what deals are available based on your county. All counties have the PPO Medica Insure plan; individual counties like the Council Bluffs Metro area may have some other low-cost plans.
You’ll also have nationwide coverage whenever you travel. Iowans looking for the freedom of a PPO plan should think about Medica.
2. Wellmark Blue Cross Blue Shield
Wellmark features a network that covers 99% of doctors and 100% of hospitals in Iowa. Its PPO plans are high deductible health plans (HDHP) with HSA. That means you’ll be able to use tax-free money on eligible medical expenses.
Preventive care services like annual exams, well-child visits and mammograms are free. Most drugs are covered through the Blue Simplicity RX coverage. And you can also go to Blue Cross Blue Shield partners across the nation when you travel.
It’s important to note the PPO plans cover vision for children but not dental. You must buy add-on coverage, or you can bundle with Blue Dental for you and your children.
3. Iowa Farm Bureau Foundation
The Iowa Farm Bureau Foundation (IFBF) has partnered with Wellmark to offer 3 HMO plans, 1 of which is an HDHP with HSA. You must enroll in the foundation to be eligible, which costs $55 or less depending upon where you live.
IFBF is a smart choice for people who are self-employed, uninsured, on short-term plans or those who can’t afford coverage through a spouse’s work plan. They partner with Wellmark so you can expect benefits including:
- Free preventive care
- Virtual doctor’s visits
- Covers 100% of Iowa hospitals
- Covers 97% of Iowa physicians
IFBF offers up to 50% savings over existing ACA plans. For example, one Iowa woman saved $6,000 annually and another couple saved $16,000 per year. If you’re already a member of the foundation or have considered joining, then IFBF might be a smart choice for affordable health insurance.
4. UnitedHealthcare (30 Days to 3 Months)
UnitedHealthcare offers a fast and flexible choice for people who are making a life transition. This may be a good option for the following circumstances:
- You missed open enrollment and didn’t qualify for special enrollment.
- You just moved to the state.
- You’re between jobs.
- You need a bridge between now and when your Medicare coverage starts.
Please note that short-term insurance plans, unlike ACA plans, may require you to answer medical questions to qualify. These plans do not cover preexisting coverages or guarantee you’ll receive coverage. This HMO-styled plan gives no coverage for out-of-network expenses. But it has a nationwide network if you travel.
If you’re in a season of change, then UnitedHealthcare may be the best way to avoid paying the out-of-pocket cost of health care.
Finding Affordable Coverage in Iowa
How to get health insurance has been a hard question to answer for many Iowa families. After doing a little research and making your list, you should be on your way to navigating the options.
The best strategy is to get quotes from multiple companies. Make sure you get the coverage important to you and your family, and always read your plan before locking in your choice.
Frequently Asked Questions
1) Q: Is health insurance required?
The federal mandate that required health insurance has been lifted but some states have enacted state-level mandates that require residents to have health insurance. Even where not required, health insurance can protect your family against catastrophic healthcare costs and help make routine medical expenses more predictable. Get your most affordable quote through our top providers today.
2) Q: What does health insurance cover?
Most health insurance plans provide the 10 essential health benefits that were part of Obamacare requirements. Coverages include preventative and wellness services, prescription drug coverage, emergency services, ambulatory services, lab services, pediatric services, and more. Many plans cover a wider range of healthcare expenses but may cost more than basic plans or may have higher out-of-pocket costs for some services.Get a custom health insurance quote to cover you and your family today.
3) Q: How can I save money on health insurance?
For healthcare plans that comply with the Affordable Care Act, only a handful of rating factors affect your premium. These include age and location, at least one of which can’t be changed. Smokers will pay more in most cases and your choice of plan level can affect premiums as well. Choosing a high deductible health insurance plan can reduce the cost of premiums. These plans can be combined with a health savings account to take advantage of tax-free savings for healthcare expenses. Get the cheapest health insurance premium from top providers.