6.3 Part B Medical Payments

What Medical Payments Coverage Is

Part B — Medical Payments, often called MedPay, is first-party, no-fault coverage. It pays reasonable expenses for necessary medical and funeral services arising from bodily injury in an auto accident, regardless of fault. The expenses must be incurred within three years of the accident date — a heavily tested detail.

What Part B Pays For

Covered services include physician and hospital bills, surgery, X-rays and diagnostics, ambulance, professional nursing, prosthetic devices, dental treatment for accidental injury, and funeral expenses. It does not pay lost wages or pain and suffering — those come from Part A through an at-fault party, or from Personal Injury Protection (PIP) in no-fault states.

Who Is Covered

• "You" and family members are covered while occupying any auto (owned or non-owned) and when struck as a pedestrian by a motor vehicle.
• Any other person is covered only while occupying the covered auto.

Tested point: the named insured struck while crossing a parking lot is covered. A casual passenger struck as a pedestrian in a separate incident is not — outside occupants get coverage only inside the covered auto.

How Limits Apply

Limits are per person. With a $5,000 Part B limit, every injured covered person has a separate $5,000.

There is no per-accident cap, so total payout can far exceed the stated limit in a multi-occupant crash.

Part B vs. Part A

Coordination and Subrogation

Part B is generally excess over any auto policy on a non-owned vehicle the insured occupies, but primary in the insured's own covered auto. After paying, the insurer usually holds a right of subrogation against an at-fault party so the insured is not paid twice. In a fault state, the payment order is typically: (1) MedPay, (2) the insured's health insurance, (3) the at-fault driver's Part A liability.

Part B Exclusions

MedPay vs. PIP

In tort states, MedPay pays the insured's and passengers' bills immediately, before any fault fight. In no-fault states, PIP provides broader benefits (medical plus lost wages and essential services), so MedPay is often sold as a smaller excess layer or to fill PIP deductibles and co-pays. Candidates must not confuse the two: MedPay never pays lost wages, while PIP does. The exam frequently pairs a MedPay fact pattern with a distractor describing a PIP benefit such as lost income — recognizing that lost wages belong to PIP, not Part B, is the key.

Worked Pedestrian Scenario

The named insured is jogging and is struck by a passing car; medical bills total $7,000 and the Part B limit is $10,000. Because the named insured is covered as a pedestrian struck by a motor vehicle, MedPay pays the full $7,000 with no fault inquiry. A friend struck in a separate incident while not occupying the insured's auto would receive nothing under this policy.

Exam tip: remember Part B's three anchors — first-party, no-fault, per-person — and the three-year expense window.

What Counts as a Covered Medical Expense

Part B is broader on service type than candidates expect but strict on time. Covered: physician, hospital, surgical, X-ray, dental (for accidental injury, not routine work), prosthetic devices, professional nursing, ambulance, and funeral services. Not covered: lost wages, pain and suffering, or expenses first incurred more than three years after the accident — even for an injury clearly caused by the accident. So a covered occupant who needs a follow-up surgery in year four collects nothing under Part B, a recurring time-bar trap.

Excess, Primary, and the Stacking Question

When the injured person is in a non-owned auto, that auto's own MedPay (if any) is usually primary and the insured's PAP MedPay is excess — it pays only after the host vehicle's coverage is exhausted. A person cannot stack MedPay across two of the named insured's own policies to multiply the limit on a single injury; the policies coordinate so the insured collects the higher single limit, not the sum. Recognizing which policy pays first, and that MedPay does not stack on the same loss, is the practical coordination skill tested here.

Coordination and Subrogation

MedPay is often excess or coordinated with health insurance, and many policies subrogate: if the insured recovers from an at-fault third party, the insurer may seek reimbursement of MedPay it advanced. The per-person limit applies separately to each injured person per accident, and the three-year window means expenses incurred within three years of the accident are eligible — a covered injury that worsens four years later collects nothing under Part B.