Iowa's sole insurer in the Affordable Care Act marketplace said Monday that thousands of Iowans have signed up for health insurance plans that have zero premiums.

Minnesota-based Medica said that, as of Nov. 24, about 5,000 Iowans had enrolled in plans this year that have no-cost premiums. The company said they accounted for about 25 to 30 percent of all those who have signed up for coverage.

This Friday, Dec. 15, is the deadline for people to sign up for Affordable Care Act plans, and Medica and others were emphasizing the availability of the plans for people who qualify for premium tax credits.

"We recognize that 2018 is a very challenging year for people who purchase health insurance on their own and that premiums are high," said Geoff Bartsh, vice president and general manager for individual and family business at Medica. "It is important to remember that many consumers will be able to obtain health coverage at significant price reductions through premium tax credits."

Medica's average premium is 57 percent higher than last year, a significant increase for people who buy coverage off the exchange or who don't qualify for tax credits.

Iowa's insurance commissioner has estimated that the big price spike will cause as many as 22,000 Iowans to drop out of the individual insurance market.

However, because of the way that insurers like Medica reacted to the Trump administration's decision to rescind funding to insurers for cost-sharing subsidies, that has made zero-premium plans available in many places for people who qualify for tax credits.

Medica said that, in general, its zero-premium plans are at the bronze level, which pay on average 60 percent of medical claims.

As of Dec. 2, about 22,000 Iowans had selected insurance plans on the exchange, according to the federal Centers for Medicare and Medicaid Services. The figure doesn't include those who are automatically renewed.

Enrollment in Iowa through five weeks this year is roughly on par with the number of people who had selected plans through six weeks last year. However, people only have six weeks to sign up for coverage this year. Last year, they had three months.

The no-cost premiums came about because many health insurers who lost funding for cost sharing subsidies aimed at lowering out-of-pocket costs for low- to moderate-income people, raised premiums on silver-level plans as a result.

Since premium tax credits are pegged to the cost of the second lowest silver plan, that has meant more premium assistance for other plans.

Local navigators also have said that it's not just bronze level plans that are drawing interest but also gold level plans, which pays, on average, 80 percent of claims.

Richard Schillig, an independent insurance agent in Bettendorf, said Monday that many people aren't aware they may qualify for zero premium policies. He also he noted it is important for people to update their records, including their income, so they qualify for the right amount of premium tax credits.

People can qualify for premium tax credits if their household income is between 100 percent and 400 percent of the poverty level, or between $12,060 and $48,240 for an individual.

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