Medicaid in Iowa
Iowa expanded Medicaid effective January 1, 2014, but used a unique approach. The Iowa Health and Wellness Plan covers adults earning up to 138% FPL (about $22,025 for a single person under the guidelines used for 2027 coverage). In its early years, some expansion adults were placed in private marketplace plans funded by Medicaid dollars, similar to Arkansas's private option. Today, expansion enrollees get coverage through Iowa Medicaid's managed care plans.
Iowa Medicaid overall covers about 800,000 residents, including over 150,000 through the expansion. The state privatized its Medicaid program in 2016, contracting with managed care organizations to administer benefits. The transition was controversial and led to complaints about access and administrative issues, though the program has stabilized over time.
Iowa's uninsured rate is about 4.5%, one of the lowest in the country. Roughly 140,000 Iowans remain uninsured. The low uninsured rate reflects both Medicaid expansion and Iowa's relatively strong employer-based coverage market.
What plans cost in 2027
Iowa is one of the milder states for 2027 price changes. Based on HealthCare.gov plan data, the benchmark Silver plan for a 40-year-old in Polk County (Des Moines) costs about $483 per month before subsidies in 2027, up from about $459 in 2026 (roughly 5%). In Linn County (Cedar Rapids) it is about $536, up from $486. Wellmark, which covers about 80,000 individual market members, filed for an average increase of 4.4%, while smaller carriers asked for more.
Iowa had approximately 65,000 marketplace enrollees for 2025. The state's marketplace had a near-death experience in 2017 and 2018 when carriers fled the state, leaving Medica as the sole insurer for 94 of 99 counties. Since then, the market has recovered with additional carriers entering or re-entering, and for 2027 it no longer depends on Medica at all.
The enhanced premium tax credits expired after 2025 and were not extended for 2027, so Iowa enrollees above 400% FPL ($63,840 for an individual) get no subsidy. Iowa's relatively low cost of living means the 400% FPL threshold captures a larger share of middle-income residents than in high-cost states.
Carriers in Iowa (2027)
Five insurers offer marketplace plans in Iowa for 2027. Medica, which sold plans in all 99 counties for 2026, has left the Iowa individual market, so Medica members need to choose a new plan during Open Enrollment. The 2027 carriers:
- Wellmark Blue Cross Blue Shield(Wellmark Health Plan of Iowa) is Iowa's dominant insurer overall, with about 80,000 individual market members, and sells marketplace plans statewide. Wellmark has the largest provider network in the state.
- Ambetter (Iowa Total Care), a Centene company, expanded from 58 counties in 2026 to 73 counties for 2027. Ambetter plans tend to have lower premiums with narrower networks.
- Oscar Health sells plans in 78 counties, including Des Moines, Cedar Rapids, Iowa City, and the Quad Cities, with a tech-focused approach built around virtual care and a streamlined app.
- UnitedHealthcare offers plans in 17 counties in southwest Iowa, including Pottawattamie County (Council Bluffs).
- Avera Health Plans, based in Sioux Falls, offers plans in 7 counties in northwest Iowa, including Sioux County.
Carrier availability varies by county. Des Moines, Cedar Rapids, Iowa City, and the Quad Cities each have three carriers for 2027 (Wellmark, Ambetter, and Oscar), and parts of southwest and northwest Iowa add UnitedHealthcare or Avera.
Key regions
Des Moines metro
Polk County and the surrounding area have three marketplace carriers for 2027. MercyOne Des Moines Medical Center, UnityPoint Health (Iowa Methodist and Iowa Lutheran hospitals), and Broadlawns Medical Center are the major facilities. The metro area is well-served by specialists.
Cedar Rapids and Iowa City corridor
University of Iowa Hospitals and Clinics (UIHC) in Iowa City is the state's academic medical center and the referral destination for complex care from across Iowa. Linn County (Cedar Rapids) is served by UnityPoint Health St. Luke's and Mercy Medical Center. Wellmark, Ambetter, and Oscar all sell plans in this corridor.
Quad Cities (Davenport, Bettendorf)
The Iowa side of the Quad Cities is served by Genesis Health System and UnityPoint Health Trinity. Being on the Illinois border, some residents access care in the Illinois Quad Cities as well. Check whether cross-state providers are in-network for your plan.
Rural Iowa
Iowa has experienced significant rural hospital pressure, with several critical access hospitals reducing services or closing. In many rural counties, the nearest hospital may be 30 to 60 minutes away. With Medica gone, Wellmark is the carrier available in every county for 2027. If you live in a rural area, confirm that your plan has adequate in-network providers within a reasonable distance.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Iowa-specific things to know
Iowa's marketplace is still small.After the near-collapse in 2018, carrier participation has improved, but most counties have three carriers or fewer. Medica's exit for 2027 is a reminder that options can change from year to year, so compare plans every Open Enrollment instead of letting your plan renew automatically. Open Enrollment for 2027 runs from November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1.
The Iowa Health and Wellness Plan has its own rules. If you qualify for the expansion (income up to 138% FPL), your experience may differ from Medicaid in other states. Make sure you understand your managed care plan's network and any cost-sharing rules.
Free enrollment help is available. Iowa has certified navigators and application counselors throughout the state. The Iowa Insurance Division also provides consumer assistance for insurance questions and complaints.
Resources
- HealthCare.gov for marketplace enrollment (Iowa uses the federal marketplace)
- Iowa Health and Wellness Plan for Medicaid expansion enrollment
- Iowa Insurance Division for consumer assistance and insurance complaints