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Posted by on Sep 18, 2013 in Iowa | 0 comments

Iowa’s Health Insurance Marketplace

State Federal Partnership Exchange

What type of exchange did Iowa establish and where do I go to shop for health insurance coverage?

On December 14, 2012, Governor Terry Branstad stated in a letter to Health and Human Services Secretary Kathleen Sebelius that Iowa would pursue a state-federal partnership health insurance exchange. Iowa will retain and operate certain functions of the Exchange including plan management functions and determining Medicaid and CHIP eligibility determinations. The state intends to transition to a fully state-based exchange in 2015. Come October 1, 2013, consumers in Iowa can use the federal website, HealthCare.gov, to compare health insurance options, apply for federal subsidies, and enroll in coverage.

How many carriers will be offering coverage through Iowa’s Health Insurance Marketplace?

On July 1, 2013, the Iowa Insurance Division announced that Six Health Insurers Applied to Offer Health Care Coverage on Iowa’s Health Insurance Marketplace. On August 1, 2013, it was announced that the Iowa Insurance Division Completed Its Review and Approval of Filings for Health Insurance Plans to be Offered on its Health Insurance Marketplace.

“The plans were evaluated on the basis of their compliance with design standards set for the state and for the rates to be charged for various categories of enrollees, based on their age, residency and smoker status. Now that the Iowa review has resulted in a provisional approval of each of the submitted plans in the form of prerequisite state, the filings will proceed for a federal government review that must occur prior to their determination of the plans’ eligibility for use in Iowa’s federally-administered Marketplace.”

On September 12, 2013, the Health Care Exchange Participating Insurers Confirmed Their Commitment as Each of the insurers who filed Qualified Health Plan applications for review by the Iowa Insurance Division in June … signed their contracts with the Department of Health and Human Services to offer their health plans on the Affordable Care Act (ACA) federal marketplace for Iowa.”

Will coverage and premiums be the same statewide?

In Iowa, only two insurers, Coventry Health Care of Iowa and CoOportunity Health, will be offering health insurance plans statewide.

Iowa’s 99 counties have been divided into seven geographic rating areas. Different regions have different health care costs and premiums can vary by region depending on those costs. The rating areas are one factor used to help determine health insurance premiums. Here is a breakdown of the rating areas in Iowa:

AREA COUNTIES
1 Boone, Calhoun, Carroll, Greene, Grundy, Hamilton, Hardin, Marshall, Poweshiek, Story, Tama, Webster
2 Dallas, Jasper, Madison, Marion, Polk, Warren
3 Buena Vista, Cherokee, Clay, Crawford, Dickinson, Ida, Lyon, Monona, O’Brien, Osceola,, Palo Alto, Plymouth, Pocahontas, Sac, Sioux, Woodbury
4 Adair, Adams, Audubon, Cass, Clarke, Decatur, Fremont, Guthrie, Harrison, Mills, Montgomery, Page, Pottawattamie, Ringgold, Shelby, Taylor, Union
5 Appanoose, Davis, Des Moines, Henry, Jefferson, Keokuk, Lee, Louisa, Lucas, Mahaska, Monroe, Muscatine, Van Buren, Wapello, Washington, Wayne
6 Benton, Black Hawk, Buchanan, Cedar, Clayton, Clinton, Delaware, Dubuque, Iowa, Jackson, Johnson, Jones, Linn, Scott
7 Allamakee, Bremer, Butler, Cerro Gordo, Chickasaw, Emmet, Fayette, Floyd, Franklin, Hancock, Howard, Humboldt, Kossuth, Mitchell, Winnebago, Winneshiek, Worth, Wright

Which companies will be offering coverage through the Health Insurance Exchange in Iowa?     

Medical Carriers

CoOportunity Health, originally named Midwest Members Health, is a new non-profit insurer that will offer coverage in Iowa and Nebraska. In Iowa, options will be available statewide at the platinum, gold, silver, bronze, and catastrophic metal levels for individuals on the new Health Insurance Exchange and for small groups on the SHOP Exchange. CoOportunity Health will also offer coverage options off the Exchange for individuals, small groups, and mid and large employers.

The CoOportunity Premier PPO plan will use the Midlands Choice Premier provider network, which includes 100 percent of hospitals and 97 percent of practitioners in Iowa. Members will also have access to a National provider network, PHCS Network and the MultiPlan Network.

CoOportunity Choice UI Health Alliance will be available in all of Iowa’s 99 counties. This open-access, tiered benefit design plan provides savings when Tier 1, University of Iowa Health Alliance facilities and clinicians are used for services.  Tier 2 includes additional providers that participate in the Midlands Choice Premier network. Under Tier 2, members will also have access to a national provider network through the PHCS Network and the MultiPlan Network. Tier 3 covers out-of-network providers.

CoOp-Statewide_Area

CoOportunity Preferred UI Health Alliance, EPO, narrow network plan provides the most cost-effective choice for purchasers interested in using UI Health Alliance providers exclusively. The CoOportunity Preferred plan is available in select counties, here is a map of the Preferred service area:

CoOp-Select_Area

Coventry Health Care of Iowa will be offering individual plans statewide. UnityPoint Health (formerly Iowa Health System) and its local system, Trinity, have partnered with Coventry for the Carelink high-performance network plans.

Avera Health Plans, a wholly owned subsidiary of Avera Health, will offer individual and small group HMO plans in northwestern Iowa. Take a look at the Avera service area:

Avera-Service_Area

Gundersen Health Plan, Inc., a subsidiary of Gundersen Health System, operates in northeastern Iowa. Gundersen will be offering individual and small group exchange products.

Sanford Health will be offering small group products in Iowa.

Health Alliance Midwest, Inc will be offering exchange plans in several Midwest states in 2014. In Iowa, Health Alliance will be offering small group products.   

Dental Stand-Alone

The Guardian Life Insurance Company of America

Dentegra Insurance Company

Delta Dental Plan of Iowa

BEST Life and Health Insurance Company

New information is being released every day. Follow this blog to receive updates as new information is released in Iowa.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

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