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Iowa Health Insurance

Iowa Medical Insurance Overview

Despite the population of the state that doesn’t have insurance benefits is small compared to the other 49 states in the country, the state of health for Iowa’s residents is relatively poor and has a great deal of room for improvement.  Many healthcare reform efforts aim to make insurance accessible on a grander scale, but the Affordable Care Act seeks to increase the percentage of those covered under benefits packages nationwide.

The ACA will continue to change the landscape of health insurance plans in the entire country and by 2020, the country will see another 30 million more insured Americans.

Iowa’s Health Care Issues
Iowa’s placing in comparison to other states in the country is the 22nd position which is a tremendous jump from 41st place in 2011.  Iowa has a very low percentage of residents who are uninsured along with a high percentage of high school graduates and a low infant mortality rate.  Weaknesses plaguing the state are the presence of excessive drinkers, limited doctor availability and low vaccination percentages among adolescents in the state.

Understanding Iowa’s Uninsured Population
A report compiled by the University of Iowa of Public Policy Center states that a third of those in the state who don’t have insurance coverage are represented with incomes below the Federal Poverty Level.  Conversely, there are ten percent of residents in this state who earn 400 percent of the poverty level and opt not to purchase insurance benefits.  The report shows that there are more males without insurance than females and the majority of those who are uninsured in this state are Caucasian people.

The following represents statistic with regard to the uninsured population of Iowa, which are offered by the Henry J. Kaiser Family Foundation.

  • 6% of those living in Iowa don’t have insurance coverage.
  • 15% of the poor children in the state of Iowa are not insured and 12% of low income kids in the state don’t have insurance benefits.
  • Poor adults make up the largest demographic of uninsured people in the state.  37% of poor adults in the state don’t have health benefits.

Group Health Plans
For those working in the state of Iowa, you can typically obtain insurance benefits through your job.  Nearly 53% of residents living in the state of Iowa are covered by insurance benefits.
Under half of the companies that operate in Iowa offer insurance benefits to their employees.  This is still less than the national average with regard to companies that offer group benefits to workers.  No matter what state you live in when seeking out benefits, you should first ask your employer if the company offers group health benefits.  The Iowa Insurance Division it tasked with regulating the group health insurance plans in the state of Iowa.

Signing Up
If you want to sign up for coverage under the company’s insurance package, speak with your HR rep to determine the enrollment period for joining the plan.  Afterward, you can research the plan’s options and the costs for each level of coverage so that you can make an educated insurance decision.  When looking into whether or not you should join up for your employer’s group plan, think about the following factors:

  • Do you have chronic conditions that require coverage?
  • Is there more than one plan option of which you can select?  Perhaps your employer offers an expensive option that has comprehensive coverage while less expensive plans offer a lower amount of coverage.
  • Are you covering your spouse or dependents?  If you answered yes, you should mention that early in the enrollment process so they are included in your insurance contract.

Pre-Existing Condition Exclusion Periods
For people under group plans who have pre-existing health conditions, you may have to wait out an exclusion period before you can use your health benefits.  In the state of Iowa, you cannot be made to wait out an exclusion period that lasts longer than a year and your insurance provider has a look back period of six months in determining whether or not you have a pre-existing condition.
The following information represents some factors you should be aware of regarding exclusion periods due to pre-existing medical conditions:

  • Any dependents under your plan who are 19 years of age or younger are not required to wait out exclusion periods.
  • Despite the applicable exclusion period due to pre-existing conditions, the presence of such a condition cannot preclude you from obtaining insurance coverage under your company’s group plan due to HIPAA regulations.
  • If you have a genetic predisposition toward the development of a condition or disease, this does not constitute a pre-existing condition and cannot be treated as such in the absence of a diagnosis or subsequent treatment.

If you have a pre-existing medical condition, you are likely to be subject to an exclusion period before you can begin drawing benefits from your new insurance policy. In Iowa, this exclusion period can last up to 12 months, and your employer could look back six months into your medical history to determine if you have any pre-existing medical conditions.

Affiliation or Waiting Periods
Affiliation periods apply right after you complete the enrollment process and can last for up to two months.  The only exception to the rule is for those who are enrolling into the plan late and that extends the affiliation period to three months.  Affiliation periods apply without regard to the absence or presence of pre-existing conditions or medical history data.

Individual Health Plans
Individuals living in Iowa are able to secure coverage under individual insurance policies, but this should only be the case if your workplace doesn’t offer benefits or you can’t get any of the state-funded benefits programs.  Eight percent of residents in the state of Iowa are covered under individual insurance contracts.

Despite the percentage of covered parties under this plan type, individual policies can be expensive and are subject to a lot of underwriting on the part of the insurance provider.  You can also have your benefits limited by the provider in the event you have a pre-existing medical condition.

It is believed that a young, healthy person in the state of Iowa can obtain coverage under this policy type for a figure of $50 every month.

Continuation Coverage
Continuation insurance coverage is available to residents who have lost their insurance standing in the state of Iowa for reasons like job loss or divorce.  If you have had a change in employment or marital status, you can apply for benefits under the COBRA (Consolidated Omnibus Reconciliation Act) for continued insurance for a period of 18 months.  The only stipulation for coverage is the size of the company that originally provided the group health plan.

Iowa Health Benefits Marketplace 
Iowa is one of the states that has partnered with the federal government to offer benefits on Healthcare.gov.  The announcement was made in 2012 to combine the efforts of the state and federal governments to create the benefits exchange in the state of Iowa.  Since the year 2015, the state has run its marketplace with the intention of providing cost saving solutions to residents along with plan options.  In 2016, the state has planned on managing the benefits exchange without the assistance of the federal government.

Iowa State Insurance Programs
The state of Iowa has funded many programs to aid those in need of insurance benefits but earn low wages.  Twenty-five percent of those people living in Iowa receive benefits under different state-funded plans.  In order to figure out if you are eligible for coverage, you must meet certain age, gender and income requirements.  There are a wide variety of plan options available to you and each has detailed information provided below.

Health Insurance Plan of Iowa (HIPIOWA) and HIPIOWA-FED
The two plans listed here worked in tandem to cover people who have severe, chronic or pre-existing conditions in Iowa.  Those who apply can obtain coverage if they have been denied insurance coverage for medical reasons.  Premiums cost between $107 and $1,302.

Medicaid and Medicaid for Employed People with Disabilities (MEPD)
Medicaid covers low wage earners in the state of Iowa and there are great magnitudes of medical services offered.  Your income determines whether or not you can obtain coverage under this program, but premiums might be as low as no cost for qualified individuals.

IowaCare
Uninsured adults without dependents and pregnant women can obtain benefits coverage under this plan.  Services offered include doctor’s visits, hospitalization and dental coverage.  In order to qualify, you must earn 150% or under the Federal Poverty Level and premiums are at no cost.

HAWK-I
If you earn too much to qualify for Medicaid in Iowa, you may be eligible for benefits under this program.  If your income level is under 300% of the FPL, you can obtain hospital care, medications, outpatient services and immunizations under HAWK-I.

Emergency Medicaid
Immigrants in Iowa who are waiting to receive citizenship in the United States might be able to obtain coverage under the Emergency Medicaid program.  Income earned is a determining factor of whether or not a person can get coverage and there are a wide variety of services offered.

Indian Health Services
IHS offers medical services to people of Indian descent and women pregnant with qualifying children of the same ethnic background.  You can receive in and outpatient service, physical therapy, treatment for diabetes, emergency room services and optometry through IHS.  In order to be eligible, you must be a member of a Native American tribal group or be pregnant by a man who is.

Medicare and the Medicare Prescription Drug Program
The Medicare and its Prescription Drug Program are offered to senior citizens and disabled individuals in the state of Iowa.  For eligibility, you or your spouse must have worked in a Medicare covered job for ten years or more.  Another qualifying factor is a person who is suffering from end-stage renal disease or seniors over 65.

VA Medical Benefits Package
The VA has put together a benefits plan for veterans who have served our country in the armed forces for a period of 24 months in a row.  To be eligible for benefits, you must have received an honorable discharge from the military.

Partnership for Prescription Assistance
The PPA offers 475 programs for consumers to take advantage of when seeking financial help with prescription medication costs.  This program can connect you with a lot of resources offering help for your situation.

Women, Infants, and Children (WIC)
WIC is a program that is managed by the USDA Food and Nutrition Service that offers food supplements to pregnant women, their infants and children up to five years of age.  Also offered are educational programs on infant safety and breastfeeding.

National Association of Mental Illness (NAMI) Helpline
The NAMI Helpline is a volunteer network that dispenses quality resources and information to those dealing with the mentally ill.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA offers protections with regard to the privacy maintained surrounding the medical records belonging to consumers.  However, with the Affordable Care Act, new stipulations to protect consumers have been put into place with regard to insurance providers.

Under HIPAA, group plan providers cannot deny coverage to new enrollees who have pre-existing conditions.  In addition, it limits the amount of time for affiliation and exclusion periods along with the various look back periods for insurance providers to dig through your medical files.  If you have lost insurance coverage, HIPAA also has guidelines regulating continuation coverage through COBRA and beyond.

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