An Iowa Medigap insurer cannot turn you down or charge you more for your health if you apply during the six-month window that opens when you are both 65 and enrolled in Medicare Part B. Outside that six-month Medigap open enrollment window, Iowa's Medigap rules guarantee a sale only in listed situations, most with a 63-day deadline, and Iowa's Senior Health Insurance Information Program (SHIIP) says Iowans under 65 have no Medigap open enrollment at all.

In This Guide

When is Iowa's Medigap open enrollment window?

Iowa's Medigap open enrollment rule is Iowa Administrative Code rule 191-37.21. Under the rule, the Iowa Medigap open enrollment period is the six months beginning with the first day of the first month in which you are both 65 or older and enrolled for benefits under Medicare Part B.

For an application submitted before or during the six-month Iowa Medigap open enrollment period, Iowa rule 191-37.21(1) bars a Medicare supplement insurer from:

  • denying or conditioning the issuance or effectiveness of any Medigap policy available for sale in Iowa;
  • setting a different price because of your health status, claims experience, receipt of health care, or medical condition.

Iowa SHIIP puts the Iowa rule in plain terms on its supplemental insurance page: during Medigap open enrollment, "a company cannot reject you for any policy it sells, and it cannot charge you more than anyone else your age."

The Medigap Open Enrollment Period happens once. Medicare's March 2026 guide Choosing a Medigap Policy calls the Medigap Open Enrollment Period "a one-time enrollment period; it doesn't repeat every year." The same six-month floor applies nationwide under Section 1882 of the Social Security Act, which bars health-based denial or pricing for anyone who applies during the six months beginning with the first month they are 65 or older and enrolled in Part B.

Because the Iowa window is tied to Part B, an Iowan who turns 65 but delays Part B has a Medigap open enrollment window that starts only when both conditions are true. Brevy's guide to the Medigap open enrollment period covers the federal window in more depth.

How do pre-existing conditions work in an Iowa Medigap policy?

Iowa rule 191-37.21 sets two limits:

  • The look-back: an Iowa Medigap policy may exclude benefits during its first six months for a pre-existing condition that was treated or diagnosed during the six months before the coverage became effective.
  • The creditable-coverage bar: an Iowa Medigap insurer may not apply a pre-existing condition exclusion to an open enrollment applicant who, as of the application date, has had at least six months of continuous creditable coverage.

Under Iowa rule 191-37.21, a "continuous period of creditable coverage" means coverage with no break greater than 63 days. An Iowan whose prior coverage had a break longer than 63 days may not meet the Iowa six-month continuous-coverage test. Ask the insurer, in writing, how it counted your prior coverage before you sign.

Brevy's guide to Medigap and pre-existing conditions explains the federal version of the waiting period.

Can you get an Iowa Medigap policy under 65?

Iowa SHIIP's page for people with disabilities is direct: "You don't have an open enrollment for Medicare supplement policies when you are under age 65." Iowa SHIIP also states that an Iowan with Medicare Part B because of disability or end-stage renal disease (ESRD) does not get Medigap open enrollment before age 65.

What an Iowan under 65 can buy, according to Iowa SHIIP:

  • A few companies: a small number of insurance companies sell Medicare supplement policies to Iowans under 65 who have Medicare, and SHIIP lists them in its current Iowa Medicare Supplement & Premium Comparison Guide.
  • A few guarantee-issue plans: SHIIP says a few of the under-65 plans available are guarantee issue, meaning they won't turn you down, but these plans may be expensive.
  • Medical questions for the rest: SHIIP's guide says most companies ask medical questions when you apply and may not issue policies to people with some types of health conditions.

Iowa does not appear on the list of states that Medicare's Choosing a Medigap Policy guide says, at the time of printing, require insurance companies to offer at least one kind of Medigap policy to people with Medicare under 65. The Centers for Medicare & Medicaid Services (CMS) guide adds that some insurers may voluntarily sell Medigap to people under 65 in unlisted states, though those policies will probably cost more and probably use medical underwriting.

The Iowa Medigap window at 65

Turning 65 changes the answer. Iowa SHIIP's comparison guide says an Iowan who was on Medicare because of a disability any time before age 65 will get the six-month Medigap open enrollment period at 65. An Iowan turned down for Medigap at 58 can mark the calendar for the month of the 65th birthday, when the Iowa rule 191-37.21 protections apply as long as Part B is in effect.

Suspending an under-65 Iowa Medigap policy for employer coverage

Iowa SHIIP's guide describes one more under-65 option. An Iowan under 65 who is enrolled in Medicare because of a disability and holds a Medicare supplement policy can suspend that Medigap policy if later covered by an employer or union-based group health plan.

When do you have a guaranteed right to buy Medigap in Iowa?

Iowa's guaranteed issue rights are in Iowa Administrative Code rule 191-37.36. For an eligible Iowan who applies within the rule's time period, Iowa rule 191-37.36 says a Medigap insurer:

  • shall not deny or condition the issuance or effectiveness of a covered Medigap policy it offers to new enrollees;
  • shall not set the price because of health status, claims experience, receipt of health care, or medical condition;
  • shall not impose a pre-existing condition exclusion.

Iowa rule 191-37.36 also requires the applicant to submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the Medigap application, so keep every notice that shows when coverage ended, such as a termination letter from an employer plan or a Medicare Advantage disenrollment notice.

Situations Iowa rule 191-37.36 lists

The eligible persons in Iowa rule 191-37.36(3) include people in these situations:

  • Employer coverage ends: an employee welfare benefit plan that supplements Medicare terminates, or stops providing some or all of those supplemental benefits to you.
  • A Medicare Advantage plan ends, leaves, or breaks the rules: the Medicare Advantage plan's certification is terminated, the plan is discontinued where you live, you move or otherwise lose eligibility, or the organization substantially violated its contract or materially misrepresented the plan in marketing.
  • PACE at 65 or older: a person 65 or older enrolled with a Program of All-Inclusive Care for the Elderly (PACE) provider in circumstances similar to the Medicare Advantage situations above.
  • Other Medicare plans end: enrollment in a Medicare cost plan, a similar demonstration or health care prepayment plan, or a Medicare SELECT policy ends under the same kinds of circumstances.
  • Your Medigap insurer fails or misleads you: your Medigap coverage ends because of the insurer's insolvency or another involuntary termination, a substantial violation of the policy, or material misrepresentation in marketing.
  • A first-time trial ends within 12 months: you dropped a Medigap policy to enroll for the first time in a Medicare Advantage plan, cost plan, PACE, or Medicare SELECT policy, and ended that enrollment within the first 12 months.
  • A Medicare Advantage or PACE trial at 65: on first enrolling in Medicare Part B at 65 or older, you joined a Medicare Advantage plan or PACE and disenrolled no later than 12 months after the enrollment took effect.
  • Part D and a drug-covering Medigap policy: you enrolled in Medicare Part D during the initial enrollment period while holding a Medigap policy that covers outpatient prescription drugs.

Iowa SHIIP's comparison guide adds a limit on the Iowa employer-coverage right: an increase in premium or loss of Medicaid "does not trigger this benefit."

How the Iowa 63-day clocks run

Iowa rule 191-37.36(4) sets when each guaranteed issue period closes:

  • Employer plan ends: the Iowa guaranteed issue period ends 63 days after the later of the termination notice or the date the coverage ends.
  • Voluntary disenrollment: the Iowa guaranteed issue period begins 60 days before the disenrollment takes effect and ends 63 days after the effective date.
  • Other listed cases: the Iowa guaranteed issue period ends 63 days after coverage terminates or after the effective date of disenrollment.

The 60-day early start lets an Iowan who is leaving a plan voluntarily apply for Medigap before the old coverage stops, which can help avoid a gap in coverage. Missing a 63-day deadline can put you back into medical underwriting, because outside open enrollment an insurer may deny a Medigap policy to someone who doesn't meet its underwriting requirements. Brevy's national guide to Medigap guaranteed issue rights covers the federal situations in detail.

Which Medicare supplement plans can you buy in Iowa?

Iowa Medigap plans are standardized. SHIIP's comparison guide states that since January 1, 1992, companies selling Medicare supplement policies in Iowa are limited to standardized policies, and that beginning June 1, 2010, companies can only sell 10 plans identified by the letters A, B, C, D, F, G, K, L, M and N. A company does not have to sell all 10 Iowa Medigap plans. Iowa SHIIP adds that the benefits in each lettered plan are identical from company to company.

Medigap Plans C and F are available in Iowa only to people eligible for Medicare before January 1, 2020, according to Iowa SHIIP. Medicare's 2026 Choosing a Medigap Policy guide explains why: Medigap plans sold to people new to Medicare on or after January 1, 2020 can't cover the Part B deductible, so people new to Medicare have the right to buy Plans D and G instead. SHIIP's guide also notes that Medicare SELECT policies are not currently sold in Iowa.

Which Iowa Medigap plans each guaranteed issue situation opens

SHIIP's Iowa Medicare Supplement & Premium Comparison Guide lists the plans for three guaranteed issue situations, split by when you became eligible for Medicare:

  • Employer group plan that pays after Medicare stops some or all benefits (including loss of COBRA coverage): Plan A, B, C, F (including high deductible Plan F), K or L if you had Medicare before January 1, 2020; Plan A, B, D, G (including high deductible Plan G), K or L if you had Medicare on or after January 1, 2020. SHIIP says you can buy from any company selling these plans in Iowa.
  • First-time Medicare Advantage or Medicare cost plan trial, left within 12 months: re-enroll in the Medicare supplement you most recently had if the same company still offers it; if not, Plan A, B, C, F, K or L (Medicare before January 1, 2020) or Plan A, B, D, G, K or L (Medicare on or after January 1, 2020) sold in Iowa.
  • Medicare Advantage or PACE joined at 65 and left within 12 months: any Medicare supplement plan sold in Iowa, meaning A, B, C, D, F, G, K, L, M or N if you turned 65 before January 1, 2020, or A, B, D, G, K, L, M or N if you turned 65 after that date.

Iowa rule 191-37.36(6) backs up the at-65 trial: an Iowan in that situation is entitled to any Medicare supplement policy offered by any issuer. SHIIP's guide adds two limits. An Iowan under 65 buying after losing employer coverage is limited to companies that sell to people under 65. And an Iowan enrolled in Medicare Part B before 65 is not eligible for the at-65 trial right when turning 65; SHIIP notes two exceptions for people who take Part B for the first time after 65 and says to call SHIIP for details.

For the other Iowa guaranteed issue situations, such as a Medicare Advantage plan leaving your area or a Medigap insurer failing, Iowa rule 191-37.36 guarantees the sale of a Medigap policy described in subrule 191-37.36(6) that the insurer offers to new enrollees. Ask Iowa SHIIP which plans your situation covers before you apply.

Brevy's guides to how the lettered Medigap plans work and to Medigap Plan G vs. Plan N compare the letters benefit by benefit.

Should you choose Medigap or Medicare Advantage in Iowa?

Medigap works only alongside Original Medicare. Iowa SHIIP states that if you are enrolled in a Medicare Advantage plan, Medicare supplement policies don't pay benefits and aren't needed. The CMS booklet Understanding Medicare Advantage Plans likewise says you can't use Medigap to pay Medicare Advantage Plan copayments, coinsurance, deductibles, or premiums.

The same CMS booklet states that it's illegal for anyone to sell you a Medigap policy while you're in a Medicare Advantage Plan unless you're switching back to Original Medicare, and says to report such a sales attempt to your State Insurance Department. In Iowa, Medigap complaints go to the Iowa Insurance Division., Brevy's guide to illegal Medigap sales walks through the federal rule.

Dropping Medigap for Medicare Advantage is hard to undo. CMS states that in most cases, if you drop a Medigap policy to join a Medicare Advantage Plan, you may not be able to get the same policy back. The federal "trial right" lets a first-time Medicare Advantage enrollee buy a Medigap policy on returning to Original Medicare within 12 months of joining, and Iowa's version of that trial right, with its plan lists, is set out above. Brevy's comparison of Original Medicare and Medicare Advantage sets the two side by side.

How do Iowa's Medigap windows compare?

Situation Window What you can buy in Iowa
Open enrollment at 65 Six months from the first month you are 65 or older and in Part B Any policy a company sells, with no health-based denial or pricing
Under 65 on disability Medicare No Medigap open enrollment before 65 Policies from a small number of companies; a few guarantee issue plans, most with medical questions
Turning 65 after disability Medicare Six-month open enrollment at 65 Same protections as open enrollment at 65
Employer plan that pays after Medicare ends Ends 63 days after the later of the notice or the coverage end date Plan A, B, C, F, K or L (Medicare before 2020); Plan A, B, D, G, K or L (Medicare 2020 or later)
First-time Medicare Advantage or cost plan trial Leave within 12 months; a voluntary exit window runs from 60 days before to 63 days after disenrollment Your prior policy from the same company, or the same six-plan lists as the employer row
Medicare Advantage or PACE joined at 65 Leave within 12 months Any plan sold in Iowa: A, B, C, D, F, G, K, L, M or N (65 before 2020); A, B, D, G, K, L, M or N (65 after)
Medicare Advantage, cost, or SELECT plan ends, or a Medigap insurer fails Ends 63 days after coverage ends A policy described in rule 191-37.36(6); ask SHIIP which plans apply

Sources for the table: Iowa rules 191-37.21 and 191-37.36 and SHIIP's comparison guide.

How do you shop for Medigap safely in Iowa?

SHIIP's comparison guide gives Iowa Medigap buyers four protections to use:

  • Use the 30-day free look: the Iowa free-look period starts when you have the Medigap policy in your hand, and if you decide not to keep it, you return it to the company and request a premium refund in writing.
  • Check that it's guaranteed renewable: an Iowa Medigap policy bought after December 1, 1990 is guaranteed renewable, so the company can't drop you unless you fail to pay the premium.
  • Buy only from a licensed agent: an agent must hold a license issued by the State of Iowa Insurance Division to sell insurance in Iowa.
  • Report problems: Iowa Medigap complaints can be filed online with the Iowa Insurance Division at iid.iowa.gov/insurance-consumer-complaint.

Medicare's Choosing a Medigap Policy guide gives the federal version: you have 30 days to decide whether to keep a new Medigap policy, starting when you get it. Section 1882(c)(4) of the Social Security Act separately lets a Medigap policy be returned for a full refund of premiums paid during a period of not less than 30 days after it is issued.

Where can Iowans get free Medigap help?

Iowa's State Health Insurance Assistance Program runs as SHIIP-SMP, the Senior Health Insurance Information Program together with the Senior Medicare Patrol (SMP), and the Iowa Insurance Division administers it. SHIIP's comparison guide says the service is completely free and confidential and that its counselors do not sell or promote any insurance companies, agents or products. Iowa SHIIP-SMP can be reached toll-free at 1-800-351-4664 (TTY 1-800-735-2942).

Medicare's Choosing a Medigap Policy guide describes each State Health Insurance Assistance Program (SHIP) as a state program that gives free local health insurance counseling to people with Medicare and their families. SHIIP's guide also tells Iowans who can't afford their Medicare premiums to call SHIIP-SMP at 1-800-351-4664, because help may be available; Brevy's guide to Iowa Medicare Savings Programs explains the state's premium-help programs. Brevy's Iowa Medicare hub covers Iowa's Medicare options beyond Medigap.

For questions about Original Medicare itself, 1-800-MEDICARE (1-800-633-4227) is the official Medicare line run by CMS, and TTY users call 1-877-486-2048. Medicare.gov says 1-800-MEDICARE callers can talk or live chat with a real person 24 hours a day, 7 days a week, except some federal holidays.

Frequently Asked Questions

Can I apply for an Iowa Medigap policy before my Part B starts?

Yes. Iowa rule 191-37.21(1) protects a Medigap application "submitted prior to or during" the six-month open enrollment period, so an Iowan can apply in the months before Part B takes effect and keep the open enrollment protections.

How do I restart a suspended Iowa Medigap policy after losing employer coverage?

Ask the insurer in time. SHIIP's Iowa comparison guide says an Iowan under 65 on disability Medicare who suspended a Medicare supplement policy for employer or union coverage can reinstate the Medigap policy by making a request within 90 days of losing the employer coverage.

How do I check whether an Iowa Medigap agent is licensed?

Call the Iowa Insurance Division. SHIIP's comparison guide tells Iowans to check an agent's license by calling the Insurance Division at 877-955-1212 or visiting www.iid.iowa.gov.

If I replace my Iowa Medigap policy, does a new pre-existing condition wait start over?

Not if the old policy had been in effect for six months or longer. Under Social Security Act §1882(s)(2)(C), a Medigap policy that replaces another policy in effect for six months or longer may not impose a new pre-existing condition, waiting, elimination, or probationary period for similar benefits. Medicare.gov warns that if you drop a Medigap policy, you might not be able to get it or any policy back later, so keep the old Iowa policy until the new one is in force.

Learn More

MedicareMedicare Plans and Coverage in IowaMedicare in Iowa for 2026: Parts A and B costs, Medicare Advantage availability, Part D redesign, Medigap options, MSP programs, and free SHIIP counseling. MedicaidIowa Medicare Savings Programs: Help Paying Medicare CostsIowa Medicare Savings Programs in 2026: QMB, SLMB, and E-SLMB income limits, what each pays, Part D Extra Help, and how to apply through Iowa HHS. MedicareMedigap Guaranteed Issue Rights: When an Insurer Must Sell You a PolicyMedigap guaranteed issue rights are federal situations where an insurer must sell you a policy, no health questions. See the triggers and the 63-day deadline. MedicareWhen Is the Medigap Open Enrollment Period? The One Window That MattersYour Medigap Open Enrollment Period is a one-time, 6-month window that starts when you're 65 and on Part B. Buy inside it or you may be turned down later. MedicareMinnesota Medicare Supplement (Medigap): Base Plans and RidersMinnesota Medicare Supplement (Medigap) guide: the non-standard Basic and Extended Basic plans, optional riders, MN versions of K, L, M, N, and who regulates. MedicareIllinois Medicare Supplement (Medigap) and the Birthday RuleIllinois Medicare Supplement (Medigap) guide: the 45-day birthday rule for ages 65 to 75, same-insurer switches, Plan G vs N, and closed C and F plans.

Find personalized help timing your Iowa Medigap purchase inside a guaranteed window at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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