Many people do not spend enough time researching their insurance coverage options and often reject any policy add-ons offered by their insurer in an attempt to save money. One such add-on is medical payments coverage or MedPay.
Unfortunately, many people do not understand the importance of this add-on coverage until they get into a car accident and struggle with paying their medical bills.
You should always prioritize your physical and financial health when purchasing insurance coverage, and one way to ensure that you get the right amount of coverage to pay for your medical bills may be adding MedPay to your auto insurance policy when available.
Below, you will find a comprehensive guide on MedPay that answers the following questions:
- What is MedPay?
- What does MedPay cover and not cover?
- How does MedPay work?
- What is the difference between MedPay and personal injury protection (PIP)?
- Who needs MedPay?
If you have been in an automobile accident and are not sure whether you have medical payments coverage – or any other coverage to pay your medical bills, for that matter – you might want to speak with an experienced St. Louis car accident attorney.
An attorney will review your policy and advise you on your options for compensation or reimbursement for any medical expenses you have incurred.
What’s Medical Payments Coverage (MedPay)?
Most states where insurers offer MedPay, including Missouri, make it an optional add-on to an auto insurance policy.
Only three states make MedPay mandatory: Pennsylvania, New Hampshire, and Maine.
Even though your state may make medical payments coverage optional, it may still make sense to purchase it, especially if you have doubts that you can afford to pay medical bills in the event of a car accident.
Purchasing MedPay coverage may be a good idea regardless of whether or not you have health insurance. If you do, medical payments coverage may kick in to cover your out-of-pocket costs, including the health insurance deductible. If you don’t, having MedPay coverage can give you peace of mind, knowing it will address your medical expenses if you get hurt.
A car accident and its resulting medical bills may cause an immense financial burden. Motor vehicle accidents cost American society $340 billion in a recent year, equivalent to about $1,035 per person. Many individual injuries cost much more than this, however, and an injury victim might face medical bills of tens or even hundreds of thousands of dollars.
Medical Payments Coverage vs. Personal Injury Protection
Medical payments coverage is available in the vast majority of states. Typically, states that do not offer MedPay have personal injury protection coverage available instead.
The biggest similarity between MedPay and PIP coverage is that both cover your medical bills, even if you are at fault for the accident.
As for the differences between the two, there are a few:
- States available: All drivers in states with no-fault laws must carry PIP coverage as part of their auto insurance policies. In no-fault states, each driver’s own insurance will cover their medical expenses. By contrast, in at-fault states, where MedPay is typically available, the driver who caused an accident is liable for any costs incurred by the victims.
- Deductible: Typically, you must meet no deductible for MedPay. Depending on the insurance plan, PIP may have a deductible and a copay.
- The extent of coverage: PIP offers broader coverage than MedPay. Medical payments coverage, as the name implies, covers expenses related to medical care. In contrast, PIP coverage can cover both medical bills and lost income if the policyholder cannot work.
- The cost of coverage: Because MedPay is not as extensive as PIP coverage, it may cost less.
While drivers may not always have to choose between MedPay and PIP, they may wish to understand how the coverage differs so they know what they are paying for.
What Does Medical Payments Coverage Cover and Not Cover?
Medical payments coverage covers various medical expenses the policyholder and their passengers incurred.
In particular, MedPay covers bills for:
- Medical services: Including doctor’s appointments, hospitalization costs, ambulance fees, and other services related to the injuries suffered in the covered incident.
- Health insurance deductibles and copays: MedPay will cover the expenses related to deductibles and copays if you need health insurance after a car accident.
- Treatment costs: Including the cost of surgeries, medications, X-rays, and other diagnostic and treatment procedures related to the covered injuries.
- Funeral expenses: If the policyholder or any of their passengers die, MedPay will kick in to cover funeral costs.
The extent of MedPay coverage varies from one state to another and one provider to another. In Missouri, for example, MedPay coverage will generally pay for any covered medical costs up to policy limits, while some policies cover only the amount not covered by other insurance plans, such as health insurance.
However, MedPay may not pay for:
- You have surpassed coverage limits: If MedPay has paid some – but not all – of your medical expenses up to policy limits, you will most likely have to pay the remaining balance out of pocket.
- Lost income: If you missed work because of your injuries, medical payments coverage will not cover the loss of income.
- Damages suffered by other parties: MedPay coverage is available exclusively for the policyholder and their passengers. It does not cover the damages other drivers and/or passengers suffered.
- Injuries unrelated to the accident: Medical payments coverage will only cover injuries related to the accident.
MedPay coverage follows the policyholder. It means you can use your medical payments coverage for medical expenses suffered as a driver, passenger, or pedestrian. Depending on the policy, you may also be covered if you get injured outside the United States.
How Does MedPay Work?
When purchasing MedPay, you will typically select an amount of coverage or, in other words, coverage limits. The amount of coverage will affect the insurance premium, typically billed monthly.
Suppose you get into a car accident and suffer an injury that results in medical bills. In that case, your insurance provider may tap into your MedPay or health insurance coverage as the primary coverage. Even if health insurance is the primary coverage, medical payments coverage may fill in the gaps if your health insurance is insufficient.
If MedPay coverage applies to cover your medical expenses, you will not have to pay any deductibles or copays. Health insurance, however, typically has a deductible and copays.
If you cause a car accident and live in an at-fault state, your liability auto insurance will most likely cover the expenses incurred by other parties but not your own. If you also have medical payments coverage, it can provide the necessary coverage for your medical bills even if you are at fault.
Who Needs Medical Payments Coverage?
When deciding whether you need medical payments coverage, ask yourself:
- Does your health insurance plan have a high deductible or copay?
- Do you often drive passengers in your vehicle?
- What is the scope of coverage offered by your health insurance?
- Do you have liability or another mandatory auto insurance coverage?
- What would your auto insurance policy cover if you were in an accident?
- Is PIP coverage required in your state?
MedPay is not the only add-on coverage for your auto insurance policy. Another popular add-on is uninsured and underinsured motorist coverage (UM/UIM), which protects you if you get hit by a driver without insurance or whose insurance is insufficient to cover all of your damages.
Given that an estimated 12.6 percent of U.S. motorists are uninsured, UM/UIM coverage may also be worth considering.
The Guide to Choosing MedPay Limits
When purchasing medical payments coverage, one of the first questions you will face is, “How much MedPay coverage do I need?” Depending on the state and the insurance provider, medical payments coverage limits typically range between $1,000 and $10,000.
But what are those limits? Your limit will dictate how much your insurance provider will pay if you get into an accident and incur medical expenses.
Setting your MedPay limits equal to your health insurance deductible is a good rule of thumb. If you do not have health insurance in the first place, consider setting your MedPay limits higher to ensure that you have access to immediate funds to pay your medical bills incurred after an accident.
The higher the limit, the more you will pay your monthly premium.
- Example: You get into a car accident, and the cost of your medical care totals $3,000. You have a $2,000 MedPay limit, while your health insurance requires a $1,500 deductible and a copay before your provider starts to pay for your medical care. Depending on how you are billed, you can use MedPay to pay your deductible, copay, and other medical expenses not covered by health insurance. Without medical payments coverage, you will have to pay a $1,500 deductible and a copay out of pocket.
Medical Payments Coverage: Can Your Doctor Send Bills Directly to the Adjuster?
Now that you know what medical payments coverage is for and how its limits work, it can also help to understand who gets the MedPay funds when you get into an accident.
How a policyholder’s healthcare providers are billed may vary from policy to policy. Often, the healthcare provider will send bills directly to the insurance adjuster.
While this may sound convenient, it can create potential challenges.
- Example: Continuing from our previous example, you have a $2,000 MedPay limit, but this time, you incur $5,000 in medical expenses in the aftermath of a car accident, of which $1,500 is for chiropractic care. Your chiropractor knows you have medical payments coverage and sends bills directly to your MedPay adjuster. The adjuster pays $1,500 for your chiropractic care, but you are left with only $500 in medical payments coverage and the remaining $3,500 in medical expenses.
Some healthcare providers are more willing to negotiate a payment plan or even lower the amount owed by a patient than others, not to mention that some providers, including ambulance services, can seek judgments to garnish your income if you do not pay on time. In that case, paying for the ambulance services first before paying for other medical expenses will make more sense.
Many providers are willing to negotiate a monthly payment plan so that patients do not have to pay a significant amount in one payment, and some may even be open to negotiating a lower cost if a patient agrees to pay that discounted total immediately.
When deciding who to bill first, these factors are worth considering, as well as whether it is appropriate to let your healthcare providers send bills directly to your MedPay adjuster.
Consult a Car Accident Lawyer Who Can Help You Address Your Medical Bills
In many cases, an injured individual may have difficulty negotiating with healthcare providers or insurance adjusters when paying medical bills. In that situation, it is always worth contacting a skilled car accident attorney who will negotiate on your behalf and ensure you get the most from the coverage you purchased.
Unfortunately, insurance companies may deny coverage for certain or all medical bills. A knowledgeable car accident lawyer can better navigate the process to resolve the frustrating and overwhelming situation in your favor.
Seek your free consultation today. The right law firm can handle all aspects of your fault-based and no-fault insurance claims following a crash. They can handle the claims process while you focus on your physical recovery.
