2027 marketplace changes in Iowa

Which insurance companies are leaving the Iowa marketplace in 2027

Who is leaving, what's left in your county, and what to do before the deadline. Last checked October 5, 2026.

The short answer

One insurance company is leaving the Iowa marketplace for 2027.

Medica (confirmed). Medica is leaving the Iowa marketplace for 2027: it is missing from the Iowa Insurance Division's 2027 filing list, and a Medica spokesperson confirmed the exit. In 2026 it sold marketplace plans in 99 of Iowa's 99 counties. That's about 4,000 people, according to Medica. source

Altogether, 99 of Iowa's 99 counties lose at least one marketplace insurer. In 8 of them, only one marketplace insurer is left.

What one company means in a college town

If you purchase your own insurance around Ames or Iowa City, pay close attention, whether you work for yourself, are between grants or have aged out of a parent's coverage. Once Medica leaves those two counties, there's only one insurer's network available. Automatic marketplace placement can't send you to a competing company. Your priority is comparing plans within that remaining lineup and checking every physician, including specialists you visit in Des Moines or Iowa City.

The PPO question in Iowa

PPO choices on Iowa's marketplace were limited in 2026. Avera Health Plans offered them only in northwestern counties: Lyon, Osceola, Sioux, O'Brien, Clay, Dickinson and Emmet. Medica didn't offer PPO coverage, so its withdrawal doesn't eliminate those plans. If you live elsewhere in Iowa, I can help you get a private nationwide PPO. It's worth comparing if you're healthy and your income is too high for the premium tax credit. If you qualify for that credit, focus on choosing the right marketplace plan.

What's left in your county

These are the 99 Iowa counties where at least one marketplace insurer is leaving. For each one you can see who's leaving, how many marketplace insurers are left, and which ones.

Down to one insurer: Allamakee, Des Moines, Johnson, Muscatine, Pocahontas, Story, Webster and Winneshiek counties are left with only Wellmark Health Plan of Iowa, Inc. on the marketplace.

On the marketplace, PPO plans were sold in 7 of Iowa's 99 counties in 2026, and all 7 of those counties still have one after the exits. Those PPO plans come from Avera Health Plans.

See every county that loses an insurer

County	Insurer leaving	Insurers left	Who's left (2026 plans)	Marketplace PPO after
Adair	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Adams	Medica	3	Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Allamakee	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Appanoose	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Audubon	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Benton	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Black Hawk	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Boone	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Bremer	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Buchanan	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Buena Vista	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Butler	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Calhoun	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Carroll	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Cass	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Cedar	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Cerro Gordo	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Cherokee	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Chickasaw	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Clarke	Medica	3	Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Clay	Medica	2	Avera Health Plans; Wellmark Health Plan of Iowa, Inc.	Yes
Clayton	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Clinton	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Crawford	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Dallas	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Davis	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Decatur	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Delaware	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Des Moines	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Dickinson	Medica	2	Avera Health Plans; Wellmark Health Plan of Iowa, Inc.	Yes
Dubuque	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Emmet	Medica	2	Avera Health Plans; Wellmark Health Plan of Iowa, Inc.	Yes
Fayette	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Floyd	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Franklin	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Fremont	Medica	3	Ambetter (Centene); UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Greene	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Grundy	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Guthrie	Medica	3	Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Hamilton	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Hancock	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Hardin	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Harrison	Medica	3	Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Henry	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Howard	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Humboldt	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Ida	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Iowa	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Jackson	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Jasper	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Jefferson	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Johnson	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Jones	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Keokuk	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Kossuth	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Lee	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Linn	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Louisa	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Lucas	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Lyon	Medica	2	Avera Health Plans; Wellmark Health Plan of Iowa, Inc.	Yes
Madison	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Mahaska	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Marion	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Marshall	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Mills	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Mitchell	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Monona	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Monroe	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Montgomery	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Muscatine	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
O'Brien	Medica	2	Avera Health Plans; Wellmark Health Plan of Iowa, Inc.	Yes
Osceola	Medica	2	Avera Health Plans; Wellmark Health Plan of Iowa, Inc.	Yes
Page	Medica	3	Ambetter (Centene); UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Palo Alto	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Plymouth	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Pocahontas	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Polk	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Pottawattamie	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Poweshiek	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Ringgold	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Sac	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Scott	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Shelby	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Sioux	Medica	4	Ambetter (Centene); Avera Health Plans; Oscar; Wellmark Health Plan of Iowa, Inc.	Yes
Story	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Tama	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Taylor	Medica	3	Ambetter (Centene); UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Union	Medica	4	Ambetter (Centene); Oscar; UnitedHealthcare; Wellmark Health Plan of Iowa, Inc.	No
Van Buren	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Wapello	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No
Warren	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Washington	Medica	2	Ambetter (Centene); Wellmark Health Plan of Iowa, Inc.	No
Wayne	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Webster	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Winnebago	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Winneshiek	Medica	1 (only one)	Wellmark Health Plan of Iowa, Inc.	No
Woodbury	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Worth	Medica	3	Ambetter (Centene); Oscar; Wellmark Health Plan of Iowa, Inc.	No
Wright	Medica	2	Oscar; Wellmark Health Plan of Iowa, Inc.	No

County data: CMS 2026 marketplace plan data source. Insurers are counted by company, and the table uses each company's 2026 service area, so a company that enters or expands for 2027 isn't counted yet. I'll update it when the 2027 plan list publishes in late October.

What happens to your plan

Your coverage doesn't end immediately just because the insurer is leaving. The existing policy continues through December 31, 2026, and you're entitled to written notice beforehand. Federal requirements call for at least 90 calendar days of notice when an insurer discontinues a plan, or at least 180 calendar days when it withdraws completely from a state's individual market. Haven't received anything yet? Contact your insurer and request the notice.

Here's where people often misunderstand the process. Under federal regulation 45 CFR 155.335, the marketplace may place you with another insurer when your current company has no remaining marketplace plan. That's permission, not a guarantee. State law and the regulator's instructions govern the transfer. Without specific direction, the marketplace chooses a "similar" plan. The regulation doesn't require anyone to verify that your doctors or medications are covered.

Purchased your coverage directly from the insurer rather than through the marketplace? Its automatic re-enrollment provisions don't apply to your policy. You'll have to select replacement coverage on your own.

HealthCare.gov opens enrollment November 1. You should receive 2 notices by that point, one from your insurer and another from the marketplace. The marketplace notice identifies any replacement plan you'll be placed in if you haven't acted by December 15. HealthCare.gov also warns that automatic re-enrollment doesn't happen in every situation.

Choose your replacement no later than December 15 to begin coverage January 1. Enrolling from December 16 through January 15 gives you a February 1 effective date. If your previous policy ends December 31, that means going without coverage for January.

You might still qualify to enroll after the regular window closes. HealthCare.gov recognizes discontinued coverage as a qualifying event, and federal regulations allow 60 days before and 60 days after your old plan's termination to select replacement coverage. I wouldn't rely on that as your first choice. Make sure you're eligible before planning around those dates.

What to do now

The way I'd approach this depends on your particular situation and where things stand for you. Whichever route makes sense, the next step is the same: let's talk on the phone before the deadline.

Scenario 1 of 2

Your income qualifies you for help with the premium

When your household qualifies for a premium tax credit, marketplace coverage is generally the more affordable route because you can't apply that credit anywhere else. Still, don't accept an automatic plan selection without checking it. Compare every remaining insurer in your county before December 15, and verify your prescriptions and doctors against the new plan's network. Your old plan's network doesn't determine what the new one covers.

Next step: Share your estimated income, medication list and doctors with me. I'll help you choose a Iowa marketplace policy that fits before enrollment closes.

Talk it through with Sam → Call 813-999-0101

Scenario 2 of 2

You pay full price and you're healthy

If your income puts you outside the tax credit range, you're responsible for the entire marketplace premium, with your choices limited to the insurers serving your county. That's when I'd also consider private coverage. Medically underwritten plans use nationwide PPO networks, and their pricing reflects your health. Healthy applicants may pay less than the marketplace's unsubsidized rate. There are tradeoffs: insurers ask medical questions and can reject an application or exclude a preexisting condition. We'll review those details together before you decide.

Next step: Give me a call, and I'll compare a nationwide PPO quote for your household with the marketplace coverage offered in your Iowa county.

Talk it through with Sam → Call 813-999-0101

You can still get a nationwide PPO in Iowa

Regardless of which insurers remain on your county's marketplace, I can help you obtain a nationwide PPO in Iowa. On the marketplace, PPO plans were sold in 7 of Iowa's 99 counties in 2026, and all 7 of those counties still have one after the exits. Those PPO plans come from Avera Health Plans.

For healthy people paying the entire marketplace premium, it's worth comparing private, medically underwritten PPO coverage. These plans offer networks extending nationwide. I carry health insurance licenses in 36 states, including Iowa.

Questions about insurers leaving Iowa

Straight answers, no sales pitch.

Which insurance companies are leaving the Iowa marketplace in 2027?

Medica (confirmed). Altogether, 99 of Iowa's 99 counties lose at least one marketplace insurer.

If my insurance company leaves, will I be moved to a new plan automatically?

Possibly, but there's no guarantee. Federal rules permit the marketplace to assign a comparable plan from another insurer when state law and regulators allow it. HealthCare.gov specifically cautions that automatic re-enrollment isn't always available. And if your current coverage was purchased outside the marketplace, that process won't apply. My advice is to choose your replacement yourself.

What's the deadline to pick a new Iowa plan for 2027?

To start coverage January 1 through HealthCare.gov, enroll by December 15. You have until January 15 before open enrollment ends, but selecting a plan after December 15 means it won't take effect until February 1.

Can I still get a PPO in Iowa?

Yes. I can help you find a nationwide PPO available in Iowa. On the marketplace, PPO plans were sold in 7 of Iowa's 99 counties in 2026, and all 7 of those counties still have one after the exits. Those PPO plans come from Avera Health Plans.

Sources

Medica sold individual marketplace plans in 99 of 99 Iowa counties in 2026 (CMS 2026 plan data, counted by company) source
Medica is leaving the Iowa marketplace for 2027: it is missing from the Iowa Insurance Division's 2027 filing list, and a Medica spokesperson confirmed the exit. source
Medica in Iowa: about 4,000 people, according to Medica source
After the confirmed and reported exits, 99 of 99 Iowa counties lose at least one marketplace insurer and 8 are left with one, counting the 2026 plans of the companies that stay (CMS 2026 plan data) source
Iowa marketplace PPO plans in 2026: 7 of 99 counties; after the confirmed exits: 7 (CMS 2026 plan data) source
HealthCare.gov says that by November 1 you should get 2 letters, one from your current insurance company and one from the Marketplace, and that in some cases you won't be automatically re-enrolled source
45 CFR 155.335(j)(3): when no plans from the same insurer are available, the Exchange "may enroll the enrollee in a QHP issued by a different issuer, to the extent permitted by applicable State law", as the state regulator directs or, if it does not, "in a similar QHP from a different issuer, as determined by the Exchange" source
HealthCare.gov open enrollment starts November 1; enroll by December 15 for coverage that starts January 1, or December 16 to January 15 for coverage that starts February 1 source
45 CFR 155.420: losing coverage is a triggering event, the loss date is the last day of the old plan's coverage, and the person has 60 days before and 60 days after it to pick a new plan source
HealthCare.gov lists "Your individual plan or your Marketplace plan is discontinued (no longer exists)" as a qualifying event for a special enrollment period source
45 CFR 147.106: an insurer that drops a product must give written notice at least 90 calendar days before coverage ends; one that leaves a state's individual market entirely must give at least 180 calendar days notice and cannot return to that market for 5 years source
Iowa approved its 2027 individual-market rates in October 2026; the weighted average increase is about 5.7%, down from 6.7% requested (reported from state filings) source
After Medica's exit, Linn County goes from 3 marketplace insurers to 2 and Polk County goes from 4 to 3 (CMS 2026 plan data, counted by company) source
Iowa's 2026 marketplace PPO plans were sold in Clay, Dickinson, Emmet, Lyon, O'Brien, Osceola and Sioux counties (CMS 2026 plan data) source

Last checked October 5, 2026. I update this page when the 2027 plan list publishes in late October.

Got a letter? Bring it to the call.

Call me with your county, the people who need coverage and the details of your notice. I'll compare the remaining Iowa marketplace plans with a nationwide PPO quote and help you decide before enrollment ends. I'm licensed in 36 states, and we can handle everything by phone.

Book a free call → Call 813-999-0101 Send a message