6.3 Part B Medical Payments

6.3 Part B: Medical Payments Coverage

Part B — Medical Payments Coverage pays reasonable and necessary medical and funeral expenses incurred because of bodily injury caused by an auto accident and sustained by a covered person. Unlike Part A, Part B is first-party, no-fault, and not based on legal liability — the insurer pays regardless of who caused the accident. It is sometimes called "med pay."

Who is covered and the time limit

A covered person under Part B is:

1. You or any family member while occupying, or as a pedestrian struck by, a motor vehicle designed for use on public roads or a trailer.
2. Any other person while occupying your covered auto.

The expense must be incurred and the services rendered within three years from the date of the accident. Limits are written per person (commonly $1,000, $2,000, $5,000, or $10,000) and apply to each covered person separately in a single accident.

Worked per-person example

A PAP carries $5,000 per person Part B limits. The insured and two passengers are injured. Medical bills are: insured $6,500, passenger A $3,000, passenger B $8,200.

Because the limit applies per person, the total paid ($13,000) can far exceed the per-person figure ($5,000) — there is no per-accident aggregate. This per-person versus per-accident distinction is a frequent exam point.

Occupying defined

"Occupying" means in, upon, getting in, on, out of, or off a vehicle. A person leaning into a car to retrieve an item or stepping onto the running board is occupying; this broad definition is tested with fact-pattern questions. The breadth matters because a non-family passenger is covered only while occupying the covered auto — once they walk away as a pedestrian, Part B no longer follows them.

What med pay actually pays for

Reasonable expenses for necessary medical, surgical, X-ray, dental, ambulance, hospital, professional nursing, and funeral services, plus prosthetic devices, are all included. Med pay does not pay lost wages, pain and suffering, or property damage — those are general damages recovered through liability or UM/UIM. Because med pay is fault-free and pays quickly, it functions as a fast first layer of medical reimbursement while liability is being litigated.

Relationship to PIP, health insurance, and Part A

In no-fault states, statutory Personal Injury Protection (PIP) is the primary first-party medical coverage and med pay sits excess over it, often filling deductibles and coinsurance gaps. In tort states, med pay coordinates with the insured's health insurance, and many policies are written so med pay is excess over health coverage. When the insured is injured by an at-fault third party, the insured may recover medical bills under Part B and pursue the third party's Part A liability; the med-pay insurer then typically has a subrogation or reimbursement right to avoid a double recovery.

Coordination, exclusions, and traps

Med pay is excess over PIP in no-fault states and may coordinate with health insurance depending on state rules. Key Part B exclusions mirror Part A and include:

• Injury while occupying a vehicle with fewer than four wheels (motorcycles/mopeds are not your covered auto).
• Injury while the vehicle is used as a public or livery conveyance (ride-share carrying passengers for a fee).
• Injury sustained while occupying a vehicle furnished for regular use that is not insured under this policy.
• Injury occurring during the business of selling, repairing, servicing, storing, or parking vehicles.
• Injury sustained while occupying any vehicle located for use as a residence or premises.

Worked coordination example

The insured (med pay $5,000, in a no-fault state with $10,000 PIP) is injured with $12,000 in covered medical bills caused by a clearly at-fault third party with 100/300 liability.

The insured's own coverages advance the $12,000 quickly; the med-pay/PIP insurers then pursue subrogation against the at-fault driver's Part A so the insured is not paid twice. This sequencing — pay first, recover later — is exactly why first-party medical coverages exist.

Exam trap: Med pay is a per-person, no-fault coverage — it pays the insured's own medical bills even when the insured is 100% at fault, but it does NOT pay the other driver's medical bills (that is Part A's job). Also note: a pedestrian struck by a vehicle is covered for you and family members, but a non-family pedestrian is covered only while occupying your covered auto. Finally, remember the three-year incurral window — bills for treatment that begins more than three years after the accident are not covered even if the limit is unused.