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're one of the people in Ames or Iowa City who buys your own coverage, whether you're self-employed, between grants or past a parent's plan, this is the part to read. In those two counties, after Medica goes, there's no second network to compare. If the marketplace moves you automatically, it can only move you to that one company. So the work is choosing the right plan from a single list and confirming that your doctors, including any specialist in Des Moines or Iowa City, are in it.

The PPO question in Iowa

Marketplace PPOs were rare here in 2026. Avera Health Plans sold them only in the northwest corner, in Lyon, Osceola, Sioux, O'Brien, Clay, Dickinson and Emmet counties. Medica didn't sell PPOs, so its departure doesn't take those away. Everywhere else in Iowa, you can still get a PPO: a private nationwide PPO through me, which is worth pricing if you're healthy and earn too much for the premium tax credit. If you qualify for the credit, stay on the marketplace and pick carefully.

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

When an insurance company leaves, your plan doesn't stop overnight. It runs through December 31, 2026, and the company has to tell you in writing first. Federal rules require at least 90 calendar days notice when a company drops a plan, and at least 180 calendar days when it leaves a state's individual market entirely. If your company is leaving and you haven't seen that letter, call the company and ask for it.

What happens next is the part people get wrong. If no plan from your company is left on the marketplace, the federal rule (45 CFR 155.335) says the marketplace may move you to a plan from a different company. It doesn't say it will. The move has to fit state law, it follows the state regulator's direction, and without that direction the marketplace picks a "similar" plan. Nothing in that rule checks your doctors or your prescriptions.

If you bought your plan straight from the company, off the marketplace, the marketplace's re-enrollment rule doesn't reach you at all. You need to pick a new plan yourself.

Open enrollment on HealthCare.gov starts November 1. By then you should get 2 letters: one from your current company and one from the marketplace. The marketplace letter tells you which plan, if any, you'll be moved into if you do nothing by December 15. HealthCare.gov is plain that in some cases you won't be automatically re-enrolled.

Pick by December 15 and your new plan starts January 1. Pick between December 16 and January 15 and it starts February 1, which leaves January uncovered if your old plan ended December 31.

Miss open enrollment and you may still have a way in. Losing a plan because it's discontinued is on HealthCare.gov's list of qualifying events, and the federal rule gives you 60 days before and 60 days after the day your old coverage ends to pick a new plan. Don't build your plan around that window. Confirm you qualify before you count on it.

What to do now

Here's how I'd think about it, depending on where you are. Each path ends the same way: a call with me before the deadline.

Scenario 1 of 2

Your income qualifies you for help with the premium

If your household income qualifies you for the premium tax credit, the marketplace is usually where your most affordable coverage is, because that's the only place the credit can be used. So don't let the marketplace pick for you. Re-shop before December 15, look at every company still selling in your county, and check your doctors and prescriptions against the network of the plan you choose, not the one you had.

Next step: Send me your doctors, your prescriptions and your income estimate, and I'll help you pick the right Iowa marketplace plan before the deadline.

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

Scenario 2 of 2

You pay full price and you're healthy

If you earn too much for the credit, you're paying the full marketplace price, and now you're paying it for whatever is left in your county. You have another option. Private plans with medical underwriting run on nationwide PPO networks and are priced on your health, which is how the price for a healthy person can come in under the marketplace's full rate. They ask health questions up front, and the company can decline you or leave out a past condition, so we go through the details together before you choose.

Next step: Call me and I'll price a nationwide PPO for your household next to the Iowa marketplace plans in your county.

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

You can still get a nationwide PPO in Iowa

Whatever the marketplace looks like in your county, you can still get a nationwide PPO in Iowa through me. 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.

Private PPO plans with medical underwriting use networks that work across the country, and for a healthy person who pays full price on the marketplace, they're often worth pricing. I'm licensed in 36 states, and Iowa is one of them.

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?

Maybe, but don't count on it. The federal rule says the marketplace may move you to a similar plan from a different company, as state law and your state regulator allow. HealthCare.gov says that in some cases you won't be automatically re-enrolled, and if you bought off the marketplace, nobody moves you. Pick your own plan.

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

On HealthCare.gov, pick by December 15 for coverage that starts January 1. Open enrollment runs to January 15, but a plan picked after December 15 starts February 1.

Can I still get a PPO in Iowa?

Yes. You can still get a nationwide PPO in Iowa through me. 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
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.

Tell me your county, who's on your plan and what your letter says. I'll show you what's left on the Iowa marketplace, price a nationwide PPO next to it, and help you pick before the deadline. I'm licensed in 36 states and work by phone.

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