Health insurance in Iowa
123,304 Iowa residents bought a marketplace plan for 2026. What they were offered depended on which of the state's 99 counties they live in.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
Iowa uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Medicaid covers the bottom of the range in Iowa
Iowa expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.
165,300 under-65 Iowa residents are uninsured all the same, 6.4% of them — 41st of the 51 states and DC, and 0.6× the 26-state median of 9.9%.
How much choice Iowa counties get
Counties in Iowa carry between 2 and 5 insurers, so competition is fairly even across the state without being uniform.
No county in Iowa is down to a single insurer. Since the previous plan year, 76 counties in Iowa gained an insurer and none lost one.
How many Iowa residents buy on the marketplace
123,304 Iowa residents selected a marketplace plan for 2026. Against the state's under-65 population that is 48 per thousand, below the 26-state median of 79, and 24th highest of the 26 states on this site.
Of those, 17,687 — 14% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (12th of 26).
The spread inside Iowa
Polk County is the largest county we publish here, with 436,678 under-65 residents; Woodbury County is the smallest, with 87,572. Polk County has 4 insurers offering 58 plans, and Woodbury County has 4 offering 58.
The widest choice in Iowa is in Polk County — 4 insurers, 58 plans. The narrowest is Johnson County, with 2 insurers and 16 plans. Same state, same rules, 42 more plans to choose from.
Uninsured rates range from 4.1% in Dallas County to 9.0% in Woodbury County — 2.2 times as high, within one state.
The 7 largest counties in Iowa
By under-65 population, covering 46% of the state's under-65 residents. Iowa has 99 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Polk County | 436,678 | 7.0% | 4 | 58 | 46 |
| Linn County | 187,348 | 5.3% | 3 | 38 | 45 |
| Scott County | 141,985 | 5.2% | 4 | 58 | 45 |
| Johnson County | 129,488 | 6.0% | 2 | 16 | 39 |
| Black Hawk County | 104,711 | 6.6% | 3 | 42 | 46 |
| Dallas County | 100,226 | 4.1% | 3 | 42 | 44 |
| Woodbury County | 87,572 | 9.0% | 4 | 58 | 36 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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