6.3 Part B Medical Payments
Key Takeaways
- Part B pays reasonable medical and funeral expenses regardless of fault (first-party coverage).
- Limits are per person (commonly $1,000-$10,000), applied separately to each injured insured.
- Family members are covered in any vehicle and as pedestrians; non-family passengers only in the covered auto.
- Injuries must occur within a stated period (commonly 3 years) of the accident.
- Livery use, motorcycle occupancy, and workers-comp-covered injuries are excluded.
Part B: Medical Payments Coverage
Part B Medical Payments (Med Pay) is first-party coverage that pays reasonable and necessary medical and funeral expenses for bodily injury caused by an auto accident. Crucially, it pays regardless of fault — the insured does not have to prove anyone was negligent. This makes it fast-paying, no-fault-style coverage layered on top of the at-fault liability system.
Med Pay limits are stated as a single per-person amount, commonly $1,000 to $10,000 per person, applied to each injured insured in an accident.
Who Is Covered
Med Pay covers two groups:
- The named insured and family members while occupying any auto or as pedestrians struck by a motor vehicle.
- Any other person while occupying your covered auto (for example, passengers).
Notice the distinction: family members are covered as pedestrians and in any vehicle, but a non-family passenger is covered only while in the covered auto. The injury must be sustained within a stated time after the accident (commonly 3 years).
Med Pay Quick Reference
| Element | Med Pay (Part B) |
|---|---|
| Party type | First-party (pays the insured/passengers) |
| Fault required? | No — pays regardless of fault |
| Limit basis | Per person (commonly $1,000-$10,000) |
| Covered persons | Named insured & family in any auto + as pedestrians; others only in your covered auto |
| Time limit | Expenses incurred within ~3 years of the accident |
| Key exclusions | Livery/public conveyance, motorcycles (<4 wheels), workers-comp injuries, vehicles used in the auto business |
How Med Pay Pays
Worked example: A driver carries $5,000 Med Pay. In an accident the driver incurs $3,200 in medical bills and a passenger incurs $6,500. The driver collects the full $3,200. The passenger, while occupying the covered auto, collects the $5,000 per-person limit, leaving $1,500 uncovered by Med Pay (which might be sought under the at-fault party's liability coverage). The limit applies per person, not per accident, so each insured has a separate $5,000.
Exclusions and Coordination
Med Pay does not cover:
- Injury while using a vehicle as a public or livery conveyance.
- Injury sustained while occupying a vehicle with fewer than four wheels (e.g., a motorcycle) or a vehicle used in the auto business.
- Injury during the course of employment if workers compensation applies.
- Injury while using a vehicle without reasonable belief of being entitled to use it.
Med Pay is often excess over personal injury protection (PIP) in no-fault states and coordinates with health insurance per state rules.
An insured's friend is injured while riding as a passenger in the insured's covered auto. The driver of the other car was entirely at fault. How does the insured's Part B Medical Payments respond?
Which injury is covered under a standard Part B?
Coordination, Subrogation, and Exam Traps
Med Pay does not have its own deductible, and it pays even when the insured also has health coverage; in practice the insurer that pays first may seek reimbursement when the at-fault party's liability insurer pays the same medical bills. After paying Med Pay, the insurer typically has a right of reimbursement out of any liability settlement the insured later collects from the at-fault party, preventing a double recovery for the same expense.
A second trap involves the limit structure. Because the Part B limit is per person and not per accident, an insurer with four injured insureds at a $5,000 limit could pay up to $20,000 total ($5,000 each) without exhausting any single limit. Contrast this with a combined single limit on Part A, where one pool covers all claimants.
Scenario: The insured (carrying $5,000 Med Pay) is struck by a hit-and-run driver while crossing the street. Even though no other vehicle's information is available, Part B still pays the insured's medical bills as a pedestrian, because Med Pay never requires identifying or proving fault against another driver. Uninsured-motorist coverage (Part C) may also respond, but the two pay for different elements and Med Pay typically responds first for the medical bills.
PIP Coordination and Additional Med Pay Traps
In states with Personal Injury Protection (PIP), Med Pay is usually written as excess over PIP, paying only what PIP does not (such as amounts above the PIP cap or expenses PIP excludes). New Hampshire, which is not a no-fault state, sells Med Pay as primary first-party medical coverage. The exam expects you to know that Med Pay, PIP, and health insurance can overlap, and that policy and state coordination-of-benefits rules decide the payment order to prevent double recovery.
Another tested distinction: Med Pay pays medical and funeral expenses only — it does not pay lost wages, pain and suffering, or property damage, all of which must come from the at-fault party's liability coverage or from the insured's own UM/UIM. A driver who needs wage replacement after an auto injury will find no help in Part B; that is a PIP or liability function. Finally, the per-person structure means a single high-cost injury can exhaust one insured's limit while leaving every other insured's separate limit fully intact.
- Med Pay is first-party, no-fault coverage for medical and funeral expenses.
- The per-person limit applies separately to each injured insured.
- Family members are covered in any auto and as pedestrians; passengers only in the covered auto.
- Livery use, motorcycles, and workers comp situations are excluded.