All state insurance regulations will be subject to revisions over the next two years in order to comply with the key provisions of the 2010 Patient Protection and Affordable Care Act. Insurers can no longer exclude children from coverage on the basis of a pre-existing condition, and adults will enjoy the same protection by 2014. Additionally, children can remain on their parents’ health policies to the age of 26, even if they or no longer in school or if they have married.
States, working with the federal government, have been charged with implementing high-risk insurance pools to remain in effect until January 1, 2014, and to design the health insurance exchanges that will become operational at that time.
General Insurance Regulations
For individual and family Iowa health insurance plans, insurers may look back 60 months to determine the presence of a pre-existing condition and then impose an exclusion for up to 24 months. Insurers in Iowa must offer a guaranteed renewability clause, however, as well as provide cancer screening for women. OB/GYNs qualify as Primary Care Providers.
For a business to be eligible to offer group insurance, at least two employees must work a minimum of 20 hours a week. Currently, insurers can review individual applicant’s medical records for the prior six months, and, if a pre-existing condition is found, exclude coverage for that condition for 12 months unless there was a previous policy in place with no more than 63 days lapsed.
Group health insurance in the state may be supplemented with additional coverage, which makes it possible to have out-of-pocket costs covered. Policies may not be cancelled due to a medical crisis so long as the premium payments are current. Rates may, however, be raised at the time of renewal.
Health Care Exchanges
Currently Iowa is considering its options to implement a health care exchange based on the clearing house model. The state did, however, establish the Iowa Insurance Information Exchange to help consumers to compare benefits, premiums and out-of-pocket costs in order to make better coverage choices.
Pre-Existing Condition Insurance
The state’s Pre-Existing Condition Insurance Plan, HIPIOWA-FED, provides coverage for primary and specialty care, hospitalization, and prescription drugs. Monthly premiums range from $156 to $765 with a $1000 deductible and out-of-pocket limits of $2500 for medical expenses and $1000 for drug costs.
All Medicaid eligibility is based on income qualifications as a percentage of the Federal Poverty Level. The same standard is used to determine benefits under the Children’s CHIP-funded Medicaid Expansions. For children under the age of 5, Medicaid assistance is available at 144% FPL, with CHIP benefits for infants under 1 year of age at 300% FPL. In the 6-19 age group the percentages are 100 and 133 percent respectively.
Pregnant women qualify for Medicaid at 200% FPL, parents at 200%, all adults at 200%, and disabled Social Security recipients at 73%.
More than 504,000 Iowa residents receive Medicare, with approximately $5,700 spent per enrollee each year. The state’s Extra Care program helps Medicare recipients cover prescription drug costs, and the Program for All-Inclusive Care for the Elderly (PACE) is also a source of additional benefits to defray out-of-pocket expenses.