Open enrollment for Iowans who get their health coverage through the Affordable Care Act begins on Nov. 1.
For the approximate 39,000 Iowans who get their health insurance through the federal marketplace, this means they have a six week period that runs through Dec. 15 to review and change their plans. Anyone currently enrolled who doesn't submit any changes will automatically be re-enrolled in the same plan.
Iowa offers ACA-approved plans through insurance companies Medica and Wellmark. Insurance Commissioner Doug Ommen recommended those on ACA plans review their household income to make sure they still qualify for federal subsidies.
"Because we have seen under the Affordable Care Act, a real impact on those people that have earnings that based on household structure, put them outside of the subsidy range," he said.
Ommen said Iowans should research ACA plans through the federal website, healthcare.gov, or consult a licensed insurance agent to learn about their options.
According to the Iowa Insurance Division, the number of Iowans expected purchase a plan through the ACA is estimated to be around 39,600 this year. That's up slightly from last year, when nearly 38,000 Iowans bought a plan.
But it's still lower than previous years. In 2017, more than 54,000 Iowans had ACA plans, while, in 2016, more than 74,000 did.
Ommen said many Iowans have left the market after failing to qualify for federal subsidies because their income was too high. Subsidies are available to people with incomes below 400 percent of the federal poverty level.
"It really is created, created kind of a ceiling for income earning. And that's a problem that is for a lot of Iowans ... especially in good economic times," Ommen said. "If they're a small business or if they were in agriculture, they're productive, and they have good years. By doing that, they can then lose access to the subsidy structure that is designed to try to make this market work."
Nearly all Iowans who purchase a plan through the ACA also have subsidies, Ommen said.
Iowans also have a few other options for insurance.
The Farm Bureau offers insurance plans through Wellmark. The plans were approved by the Iowa Legislature in 2018 and are meant to be more affordable alternatives to ACA plans. However, some have raised questions of consumer protection standards as they're not required to follow federal health insurance laws.
Iowans can also purchase short-term health plans, which can last for up to a year under changes made by the Trump administration last year. These plans are cheaper than ACA plans, but often cover less. Unlike ACA plans, short-term health plans can exclude someone for a pre-existing condition or exclude prescription drug coverage.