2026 Health Insurance Enrollment Deadline Approaches Amid Federal ACA Changes

FOR IMMEDIATE RELEASE: Tuesday, September 30, 2025
Craig Robinson, [email protected], 515-654-6619

Des Moines, Iowa - Open enrollment for Iowans looking to purchase or change their Affordable Care Act (ACA) individual health coverage for 2026 begins Saturday, November 1, 2025 and ends on Thursday, January 15, 2026.

Iowa Insurance Commissioner Doug Ommen urged Iowans to plan carefully for the upcoming year - while also underscoring the urgent need for Congress to fix the ACA's structural flaws.

"Now is the time for Iowans to be thinking about health insurance coverage for next year. Many employers are offering health insurance coverage to their employees, but Iowans looking to purchase their own coverage through the individual market need to assess their upcoming health care needs now as open enrollment begins through healthcare.gov- especially given the changes at the federal level in the amounts of federal subsidies provided and who can receive them," Ommen said.

"The enhanced subsidies in the American Rescue Plan Act and the Inflation Reduction Act that Congress used to mask these problems are expiring at the end of 2025, and the true cost of the ACA coverage will once again be exposed," Commissioner Ommen said. "We cannot continue down this path. Iowans need the individual health insurance market to work - but it cannot work under a law that is structurally broken."

In 2025 alone, federal taxpayers will spend an estimated $630 million on advanced premium tax credits (APTCs) in Iowa for less than 112,000 Iowans. Ommen stressed that pouring money into subsidies has not solved the underlying problems.

"Money alone won't fix this," Ommen said. "We've spent hundreds of billions nationally to paper over the ACA's flaws, but the design itself is broken. Without reform, the ACA will fail the very people it was supposed to help - farmers, small business owners, and early retirees who need affordable options in the individual market. An Iowa couple that must pay the full bill may simply not be able to afford to pay nearly $20,000 for coverage on a silver plan - the cost of unsubsidized coverage. That is not a sustainable system."

Why Premiums Are Rising

Carriers have filed 2026 rate increases ranging from 12.6% to more than 25%. This is reflective of the changes to the enhanced subsidies under the federal American Rescue Plan Act (ARPA) and the Inflation Reduction Act (IRA), medical inflation and increased utilization. In 2026, the APTCs levels will also revert back to the levels originally available under the ACA, resulting in increased premium levels for those who are eligible for APTCs and making subsidies unavailable for those who have income at or above 400% of the federal poverty level (FPL).

For example, a family of four with two 28 year old adults and two 4 year old children making $63,978.50 (199% of FPL):

• In 2025, the family of four would pay a max of 1.96% of their income which equals $101.41 monthly.
• In 2026, the family of four would pay a max of 6.47% of their income which equals $344.95 monthly.

For another example, a couple, both age 55, making $95,175 (450% of FPL):

• In 2025, the couple would pay a max of 8.5% of their income which equals $651.53 monthly.
• In 2026, the couple would pay the whole premium without APTCs which equals $1,658.80 monthly.

Ommen warned that the ACAs structural flaws will once again push healthier Iowans out of the ACA market as the price paid is no longer reflective of their health risk, leaving behind a sicker, more expensive risk pool. "We saw this movie before in 2017 and 2018 when the market nearly collapsed. Without reform, we risk déjà vu all over again."

The ACA's Structural Flaws

Ommen highlights three persistent structural flaws Congress must address in reforming the ACA:

• Federal subsidies (APTCs) based only on income. This ignores age and actual health risk, which distorts the market.
• The federal subsidy cliff at 400% of FPL. A single dollar of additional income can cause families to lose all financial assistance. This is extremely problematic as Iowans estimate what they expect their income for the year to be before the year starts. This not only creates a disincentive for families to earn more during the upcoming year but can also force them to repay thousands of dollars in premium tax credits if their income unexpectedly increases.
• Flawed age-banding. Age banding sets limits on how much more older adults can be charged compared to younger adults. The ACA requires a 3:1 ratio, rather than the more actuarially sound 5:1 ratio.
  
  For example, if a younger Iowan's full premium is $200 under the ACA's 3:1 structure, the premium for an older Iowan cannot exceed $600. Enhanced APTCs have further distorted this balance. Because subsidies cap consumer contributions at a percentage of income, the practical effect has often been to flatten premiums across ages - making the ratio closer to 1:1 in reality.
  
  This ignores the very real differences in health risks between younger and older populations. The result is predictable: younger, healthier Iowans exit the market, while older, higher-risk enrollees remain - worsening the overall risk pool.

Although not an ACA structural flaw, the enhanced APTCs based on income under ARPA and the IRA have caused nationwide issues of fraud because the $0 premiums plans enabled scammers to enroll individuals into these plans without their knowledge or consent. This has resulted in negative tax consequences for those individuals unknowingly receiving APTCs and allowed carriers to receive APTCs for individuals who, because they did not know they were enrolled in the ACA plan, did not use the healthcare benefits of that plan. These fraudulent enrollments have been fully funded by Iowans and other federal tax payers. Any reform implemented by Congress should consider the negative impact of fraud related to these $0 premium plans.

"These flaws aren't minor glitches - they go to the heart of how this law functions," Ommen said. "Only Congress can fix them. Iowa has been clear: we are not giving up on the ACA. It serves a necessary purpose. But it must be repaired."

Insurers Providing ACA-compliant Coverage to Iowans

Six insurers will offer ACA-compliant individual plans in Iowa for 2026 through healthcare.gov: Avera Health Plans, Iowa Total Care (AmBetter), Medica, Oscar, UnitedHealthcare Plan of the River Valley, and Wellmark Health Plan of Iowa.

• Medica: All 99 counties.
• Wellmark Health Plan of Iowa: All 99 counties.
• Avera Health Plans - 7 counties:Clay, Dickinson, Emmet, Lyon, O'Brien, Osceola, Sioux.
• Iowa Total Care - 58 counties:Adair, Appanoose, Audubon, Benton, Boone, Buchanan, Butler, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clinton, Crawford, Davis, Decatur, Dubuque, Fayette, Floyd, Franklin, Fremont, Hancock, Hardin, Henry, Ida, Jackson, Jasper, Jefferson, Keokuk, Kossuth, Lee, Linn, Louisa, Madison, Mahaska, Marion, Mills, Monona, Monroe, Montgomery, Page, Palo Alto, Polk, Pottawattamie, Ringgold, Scott, Shelby, Sioux, Tama, Taylor, Union, Van Buren, Warren, Washington, Wayne, Winnebago, Woodbury, Worth.
• Oscar - 75 counties:Adair, Adams, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clayton, Clinton, Dallas, Decatur, Delaware, Dubuque, Fayette, Floyd, Franklin, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Howard, Humboldt, Ida, Iowa, Jackson, Jasper, Jefferson, Jones, Keokuk, Kossuth, Lucas, Madison, Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Palo Alto, Plymouth, Polk, Pottawattamie, Poweshiek, Ringgold, Sac, Scott, Shelby, Sioux, Tama, Union, Van Buren, Wapello, Warren, Wayne, Winnebago, Woodbury, Worth, Wright.
• UnitedHealthcare Plan of the River Valley - 17 counties:Adair, Adams, Audubon, Cass, Clarke, Decatur, Fremont, Guthrie, Harrison, Mills, Montgomery, Page, Pottawattamie, Ringgold, Shelby, Taylor, Union.

Enrollment Details

Iowans may preview sample 2026 premiums using the Iowa Individual ACA Premiums Explorer, though actual rates and subsidy calculations will be finalized on healthcare.govstarting November 1.

Enrollment between Nov. 1 - Dec. 15 starts coverage on January 1, 2026.

Enrollment between Dec. 16 - Jan. 15 starts coverage on February 1, 2026.

Iowans with a current ACA policy who do not actively select a plan will be automatically re-enrolled in their existing plan or a similar one.

Iowans considering changing insurance carriers should double-check to ensure your preferred healthcare provider(s) are in-network and your prescription drugs will continue to be covered.

Where Can I Get Help Deciding?

Local insurance agents, assisters and Iowa's navigators are available to help Iowans review which insurance plan may best fit their needs. Iowans can find local help by visiting https://www.healthcare.gov/find-assistance/.

Given the ACA's structural flaws with federal subsidies provided solely based on income and the subsidy cliff at 400% FPL, Iowans may want to include their accountant(s) or other type of financial planner(s) in discussions when making their health coverage choice.

The Iowa Insurance Division is also warning consumers to be wary of health insurance fraud.

"Insurance is complicated, especially with all of the changes happening in the ACA market," Ommen said. "Scammers often attempt to take advantage of folks when there are changes in law or how consumers can purchase insurance coverage. It's important for Iowans that need health coverage to talk with a licensed insurance agent to make sure the coverage fits the individual needs of that consumer and their family."

Other Coverage Options

Iowans should also consider whether employer coverage, short-term limited duration plans (STLD), Farm Bureauplans, direct primary care arrangements, or other non-ACA options better fit their needs. Licensed insurance agents and navigators are available to help consumers weigh their choices at https://www.healthcare.gov/find-assistance/.

• For individuals purchasing their own health coverage
  
  • Short-term Limited Duration Plans.
    • Recent federal changes to the enforcement of short-term limited duration plans allow the sale of these plans for up to three years in duration consistent with Iowa regulations. See Bulletin 25-05for more information.
  • Non-insurance health coverage options that include:
    • A health benefit plan sponsored by a non-profit agricultural organization such as the Farm Bureau Health Plan.
    • Direct Primary Care which can provide certain health coverages in exchange for monthly or yearly fees to providers.
    • Limited Benefit Plans which cover specific medical conditions or procedures and only provide a limited amount of reimbursement.
    • Health Care Sharing Ministries in which members contribute monthly to cover the healthcare expenses of other members based on shared religious or ethical beliefs but there is no guarantee claims will be paid.
• For those who are looking to get health coverage through their employer.
  
  • Nearly half of all Iowans receive coverage through their employer. Check with your employer to see if health insurance coverage is available to employees.
  • If you leave your job or are terminated you may be eligible for Continuation of Health Coverage (COBRA)under federal law.
  • Multiple Employer Welfare Arrangements (MEWAs) are an employee welfare benefit plan, or any other arrangement which is established or maintained for the purpose of offering or providing any benefit to employees of two or more employers as defined in section 3 of the federal Employee Retirement Income Security Act, 29 U.S.C. section 1002, paragraph 40. Iowans can view more information about MEWAs at: https://iid.iowa.gov/regulated-entities/regulated-benefit-plans/mewas-ahps.
    
• For those looking to utilize government health coverage
  
  • Certain Iowans are likely eligible for Medicare and should contact SHIIPto help get enrolled in Medicare during the Annual Enrollment Period (AEP) for Medicare which runs from October 15 to December 7 if they are:
    • 65 years of age and older.
    • Disabled and receive Social Security or Railroad Retiree disability benefits for 24 consecutive months.
    • Have a diagnosis of ALS or Lou Gehrig's Disease.
    • Have a diagnosis of end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).
      
  • Certain Iowans may be eligible for Medicaid based on health conditions or income levelsand has three programs for those receiving coverage:
    
    • Iowa Medicaid's managed care program called IA Health Link.
    • Iowa's Medicaid Fee for Service program.
    • Iowa's Hawk-I Programfor those uninsured children of working families.
  • Active-duty service members, veterans and their families may be eligible for health benefits through the federal government. Visit the U.S. Department of Veterans Affairsto find out about available options.

A Call for Reform

"Iowa needs a functional individual health insurance market and the ACA is not sustainable in its current form," Ommen concluded. "Congress must step in. We cannot expect Iowa families to shoulder impossible costs, nor can taxpayers continue to subsidize hundreds of billions on a broken structure. We need reform that creates affordability, sustainability, and a market that actually functions like insurance."