If you were just in a crash in Iowa and the medical bills are already arriving, start with this: Iowa does not use the "PIP" system you may have heard about from friends in other states. There is no personal injury protection requirement here, and most Iowa insurers don't sell it. What you have instead is an optional add-on called medical payments coverage, plus a set of rules that decide who ultimately pays. Here is how each piece works in Iowa, with the statute behind it.
Why Iowa has no PIP requirement
Iowa is an at-fault, or tort, state. The driver who caused the crash is the one responsible for your injuries and losses, and their liability insurance is supposed to pay for them. Iowa's financial responsibility law requires only liability coverage: $20,000 for bodily injury to or death of one person, $40,000 for two or more people in one accident, and $15,000 for property damage, written in shorthand as 20/40/15.1 The Iowa Insurance Division, which regulates auto insurers in the state, lists those same liability minimums as the only mandatory coverage and does not require PIP or medical payments coverage at all.2
PIP is a no-fault product. States that mandate it make your own insurer pay your early medical bills and some lost wages regardless of who caused the crash, and in exchange they restrict when you can sue. Iowa went the other direction. There is no no-fault statute in the Iowa Code, so nothing forces insurers to build PIP into a policy, and in practice they don't offer it here.
What MedPay covers in Iowa
Medical payments coverage, usually just called MedPay, is the closest thing Iowa sells to PIP. It is optional, and it is narrower. If you buy it, MedPay pays reasonable medical (and usually funeral) expenses for you and your passengers after a crash, no matter who was at fault. You can use it whether the wreck was your fault, the other driver's, or a hit-and-run.
Two things tend to surprise people. The limits are small: MedPay is commonly sold in $1,000 to $10,000 layers, so it is built to cover the first wave of bills, the ambulance ride and the ER co-pay, not a serious long-term injury. And unlike PIP in no-fault states, MedPay does not pay lost wages or the cost of help around the house. It is medical bills only. No Iowa law requires you to carry it, and there is no statutory deadline for filing a MedPay claim, though your own policy sets the notice and cooperation terms you have to meet.
How your bills get paid while fault is sorted out
Here is the practical gap. In an at-fault state, the other driver's liability insurer usually will not pay your medical bills as they come in. It pays once, in a lump sum, when your claim settles or a court rules, and only if its driver is found responsible. That can be months or years after the crash.
Your providers want to be paid now. So the money that keeps you out of collections in the meantime is usually some mix of your own health insurance, your MedPay if you bought it, and, when the at-fault driver carries too little coverage, your uninsured or underinsured coverage. Expect the bill to come back around: health insurers and MedPay carriers often claim a right to be reimbursed out of any settlement you later collect from the at-fault driver.
Uninsured and underinsured coverage is the real safety net
Even though Iowa skips PIP, it does not leave your own injuries entirely at the mercy of the other driver. Every automobile liability policy issued in Iowa must include uninsured and underinsured motorist coverage unless you formally reject it.3 This is first-party coverage, meaning it pays you when the at-fault driver has no insurance, leaves the scene, or carries limits too low to cover your losses.
The rejection rule is strict, and it works in your favor. Under Iowa Code section 516A.1, you can decline this coverage, but only through a written rejection you signed, and if it is on an insurer's form it has to be on a separate sheet of paper containing only the rejection.3 If you never signed that separate form, the coverage is in your policy even when it is not printed on the declarations page. That is worth checking after a crash, because with liability minimums frozen at 20/40/15, many at-fault drivers cannot cover a single hospital stay.1
Iowa law also shapes how much this coverage pays. The required uninsured and underinsured limits only have to match the state's minimum liability limits, not your full policy amount.4 Iowa does not allow "stacking" of these coverages across several policies where the policy language forbids it; the Legislature specifically abrogated the Iowa Supreme Court's 1990 Hernandez decision that had allowed it.4 And if your insurer pays you under this coverage, it steps into your shoes and can pursue the at-fault driver to recover what it paid.3
How fault and deadlines change what you keep
Because Iowa decides claims by fault, what you recover from the other driver turns on the state's comparative fault rule. Under Iowa Code section 668.3, your own share of fault cuts your recovery in proportion, and you are barred completely only if your percentage of fault is greater than the combined fault of everyone you are suing.5 Found 20% at fault, a $50,000 award drops to $40,000. Found 51% at fault against a single defendant, you take nothing from them. That is one more reason MedPay and uninsured or underinsured coverage are useful: both pay without regard to fault.
The deadlines are firm. You have two years from the date of the crash to file a personal injury lawsuit, and that same two-year limit covers a wrongful death claim arising from the wreck.6 A claim for vehicle or other property damage gets five years.6 MedPay itself carries no statutory deadline, but delay is still risky and evidence fades. If you need the official crash report to document what happened, you can request it through the process on our Iowa crash reports page. If your car is worth less on the market even after a solid repair, that is a separate property claim; see diminished value in Iowa.
What to do about coverage now
There has been pressure to raise Iowa's floor. A 2025 bill, Senate File 119, would have lifted the minimums to $50,000/$100,000/$25,000, matching what Iowa already requires of rideshare drivers.7 It did not become law, so the 2026 Iowa Code still sets the requirement at 20/40/15.1
The move that protects you most happens before a crash. Because Iowa gives you no PIP backstop, ask your own agent to confirm you carry MedPay and real uninsured or underinsured limits above the state minimum. After a crash, lean on your health insurance and MedPay for the immediate bills, keep every record and receipt, and if your injuries are serious or fault is disputed, talk to a lawyer before you give a recorded statement or accept a quick offer. You can start with our legal directory.
This is general information about Iowa law, not legal advice for your specific situation.
Sources
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Iowa Code section 321A.21 (minimum motor vehicle liability limits). https://www.legis.iowa.gov/docs/code/321A.21.pdf
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Iowa Insurance Division, Auto Insurance. https://iid.iowa.gov/consumers/insurance/auto
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Iowa Code chapter 516A, sections 516A.1 and 516A.4 (uninsured and underinsured coverage in every policy; written rejection; insurer subrogation). https://www.legis.iowa.gov/docs/code/516A.pdf
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Iowa Code section 516A.2 (minimum limits; no stacking; Hernandez abrogated). https://www.legis.iowa.gov/docs/code/516A.2.pdf
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Iowa Code section 668.3 (comparative fault). https://www.legis.iowa.gov/docs/code/668.3.pdf
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Iowa Code section 614.1 (two-year limit for injury to the person; five-year limit for injury to property). https://www.legis.iowa.gov/docs/code/614.1.pdf
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Iowa Senate File 119, 91st General Assembly (2025) (proposed 50/100/25 minimums). https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/SF119.html