Frequently Asked Questions

By getting health coverage, you know that your health needs will be covered and that you do not have to worry about what would happen if you had an accident.

For most people, you (and your family) should get an individual health plan through HealthCare.gov if you cannot get public health coverage, like Medicaid or Medicare, or affordable health coverage through an employer.

Speak to your employer’s Human Resources department (or your spouse’s or parent’s Human Resources department) to learn if you can get coverage through an employer. HealthCare.gov can help you figure out if you are eligible for public health coverage. If you have been determined disabled according to the Social Security Administration's rules, you may have additional ways of getting Medicaid. Talk to a benefits planner to learn more about them.

If you need more help in understanding individual health plans after reading this article, we recommend you talk to trained experts. Here are some good resources:

• HealthCare.gov has a lot of great information introducing your options. You can also call HealthCare.gov at 1-800-318-2596 or 1-855-889-4325 (TTY).
• HealthCare.gov also lists organizations that offer local help for finding the right plan for you.
• Talk to an Iowa health insurance navigator. You can call them at 1-877-474-6284 or make an appointment online.
• If you have a disability, talk to a benefits planner to learn if you have additional options.

Yes. Plans cannot deny people coverage anymore. That means that when you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer much more comprehensive coverage than many health plans did in the past, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few.

“Health insurance marketplace” is a national term used for the websites in each state that let individuals and small businesses sign up for health coverage. In Iowa, the website is called Health Insurance Marketplace, but a lot of people also call it HealthCare.gov instead, because that's its address on the web. It is operated by the federal government.

“Health exchanges” is a term that was used before HealthCare.gov was established.

There are programs that make health coverage more affordable if you have low income. If health coverage is too expensive for you, the government may help you pay for it via tax credits. If you still cannot afford a private health coverage plan, you may be able to get a public health coverage plan like Medicaid. Check HealthCare.gov to see if you can get one of these options.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

Depending on your situation, you may qualify to have the government help pay for your individual health plan via tax credits. Here's how it works:

1. When you sign up at HealthCare.gov, you give details about your family's situation. HealthCare.gov reviews that information instantly. If your family qualifies for government help to pay for individual coverage, HealthCare.gov tells you and lists insurance options for you.
2. Your insurance options list the full cost of the monthly premium, how much of that premium the government will pay each month, and how much you will pay each month. The way the government helps pay the premium is by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
3. In January or February, the government will send you a form listing how much your total health care tax credits were for the previous year. You will need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this will be sorted out when you file your taxes.

No, but depending on your income, you may get more help from the government if you get a silver level plan. Here’s how it works:

• If you can't get affordable employer-sponsored coverage, Medicaid, or Medicare and your family's income is at or below 400% of the Federal Poverty Guidelines (FPG) ($62,600 for an individual; $128,600 for a family of four), you may be able to get tax credits to help pay the premiums for individual coverage on HealthCare.gov. That means you would pay less each month. You might get this help no matter what metal your plan is.
  
• If you make 250% of the Federal Poverty Guidelines (FPG) or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you pay less each time you need medical services. If you get this help, your silver plan might actually be as good or better than many platinum or gold plans. If you do not get a silver plan, the government does not help you with these expenses.

Note: From 2021 through 2025, there was no income limit for getting subsidies that help pay individual coverage premiums. However, a 400% of FPG income limit is set to return for 2026. DB101 will be updated if there are any changes.

When HealthCare.gov looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

The bottom line: You may get help paying the premium regardless of whether you get a platinum, gold, silver, or bronze plan, but if you make less than 250% of FPG, you will only get help with your copayments and other expenses if you get a silver plan.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,650
	$5,500
	400
	307
Iowa Health and Wellness Plan (138% FPG)
Healthy and Well Kids in Iowa (Hawki) (307% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (400% FPG)
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based Medicaid eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

Add to favorites

Add to favoritesAdd to favoritesOne of my favorites

HealthCare.gov is the best place for you to get individual health coverage. Through HealthCare.gov you can apply for individual coverage or for public health coverage, such as Medicaid. HealthCare.gov will calculate your eligibility for all of these programs and, if you choose individual health coverage, will tell you how much your premium will cost you and how much the government will help with tax credits.

HealthCare.gov lets you compare health plans side-by-side and figure out which is best for you based on their costs and the benefits they offer.

Usually, when you sign up for a plan through HealthCare.gov, you cannot change plans for an entire calendar year. So, if you are signed up for 2026, then you can’t get a new plan until 2027.

However, there are certain situations when you may be able to change plans mid-year:

• If your income changes and you gain or lose eligibility for government help paying for your coverage
• If you move
• In other life-changing circumstances, such as having a child or getting married

The first one is the key. If your income goes down and you can’t afford your plan anymore, you need to report your change in income to HealthCare.gov. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).

Note: American Indians do not have these restrictions and can change up to once a month.

Most immigrants can get health coverage through HealthCare.gov. However, the rules are not identical to the rules for United States citizens. Here are the basic rules:

• Legal residents for five or more years or who meet specific noncitizen requirements have the exact same benefits as citizens. They can pay for individual plans through HealthCare.gov, qualify to get government help paying for their premiums and other fees (if their income is low enough), and get public coverage through Medicaid and other programs.

• Some non-citizens who have legal immigration status in the United States do not qualify for full Medicaid coverage, but may still qualify for private coverage subsidized by the government. Note: Starting January 1, 2026, people in this group can only get subsidies if their income is greater than 100% of the Federal Poverty Guidelines (FPG). And starting on January 1, 2027, most people in this group will not be able to get subsidies anymore.

• Immigrants who are undocumented cannot get individual plans through HealthCare.gov, cannot get government help paying for their coverage, and cannot get public coverage through Medicaid. They can purchase coverage through an insurance agent or directly from an insurer and they may qualify for other public programs or for emergency Medicaid coverage. Visit your local Health and Human Services (HHS) office to learn what programs may exist for undocumented immigrants.

If your immigration status changes and you become eligible for a public program or if you become eligible to use HealthCare.gov, you can sign up immediately—you do not need to wait until open enrollment begins.

Yes, but it is probably a bad idea. If your employer offers coverage that is affordable, you and your family will not get any help paying for an individual plan, so it will be much more expensive than the employer-provided plan.

Note: Before 2023, the spouse or children of an employee would not qualify for subsidies on HealthCare.gov if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." Learn more about affordability rules for family members and how it affects eligibility for tax credits on HealthCare.gov.