Medical Payments and Personal Injury Protection Explained

If you’ve been visiting the Metromile blog for a while, there’s a decent chance you’re well on your way to becoming a coverage connoisseur, able to effortlessly rattle off the differences between collision, comprehensive, liability, and uninsured coverage. But even if you’re just kicking off your insurance education, you’re probably already hip to the fact that not all coverage is created equal. That’s why today, we’re breaking down even more must-know terms: medical payments coverage and Personal Injury Protection (PIP).

Medical-Payments-and-Personal-Injury-Protection-Explained

The Basics: What Are Medical Payments and Personal Injury Protection Coverage?

Medical Payments Coverage

Unsurprisingly, medical payments coverage (sometimes called medical expense or MedPay) is intended to cover the costs of, well, medical payments that are the result of an accident. This type of coverage protects you no matter who is at fault for the accident. While your health insurance plan may go a long way in paying for medical costs, MedPay typically fills in the gaps and is a good go-to in the case of low limits or high deductibles. Aside from covering any necessary hospital expenses, medications, etc., medical payment insurance may help pay for any injuries sustained by your passengers, injuries you sustain as a pedestrian or bicyclist if a driver hits you, any necessary dental care resulting from the accident, and, in the worst case scenario, funeral expenses.

Personal Injury Protection Coverage

Personal Injury Protection is similar but distinct; while medical payments coverage is strictly intended to cover medical bills, PIP takes things a step further, covering health costs and resulting lost wages for you and your passengers after an accident, regardless of fault. Unlike bodily injury liability insurance, which covers damages to other people If you cause an accident, PIP pays for your expenses. And while MedPay and PIP overlap in some areas, PIP usually covers more expenses and is written specifically for car-related injuries, which are sometimes excluded from certain health insurance policies.

But all that info is general — the specifics of medical payments coverage and PIP vary from state to state. For example:
  • In California, Arizona, Illinois, and Virginia, medical payments coverage can pay medical bills for injuries you or your passengers sustained in a covered accident, up to the limit you choose (regardless of who caused the accident).
  • Pennsylvania requires something called first-party benefits for medical expenses; that just means MedPay covers medical costs, funeral costs, lost income, and any potential death benefit for the policyholder and anyone occupying the covered vehicle, at the time of the accident, no matter who’s at fault, up to a limit you choose.
  • In Washington, insurance providers are required to offer PIP to cover lost wages and benefits resulting from injury or death (residents can choose to reject this coverage).
  • MedPay isn’t offered in Oregon, but PIP is required to cover medical expenses (which may include lost wages and/or other benefits) resulting from injury or death, regardless of who’s at fault in an accident.
  • Similar to Oregon, New Jersey is considered a “no-fault” state because, regardless of who caused the accident, PIP is required to cover an array of medical, rehabilitative, and living expense options as well as lost wages.

These are just a few examples of how MedPay and PIP may vary — to find out the requirements where you live and to make sure you’re abiding by all the local laws, visit the Department of Motor Vehicle (DMV)’s state by state guide.

So Do You Really Need Medical Payments Coverage and/or PIP?

We get it, all these different types of coverage can be confusing and overwhelming, and it can be hard to know which ones fit your needs, lifestyle, and budget. But there are at least a few guidelines that can help you make the right decision.

The Legal Stuff

As mentioned above, some states require certain forms of insurance, so if you’re a driver, your decision is already made for you (at least it takes the guesswork out of the equation, right?).

Most states offer MedPay, but a handful don’t: Oregon, Minnesota, New York, and North Dakota.

    Medical Payments Coverage Is Required In:
    1. Pennsylvania
    2. Maine
    3. New Hampshire

Things are a little trickier when it comes to PIP. In addition to Washington D.C. and Puerto Rico, 15 states use the no-fault system and require drivers to buy PIP:

    Personal Injury Protection Coverage Is Required In:
    1. Delaware
    2. Florida
    3. Hawaii
    4. Kansas
    5. Kentucky
    6. Massachusetts
    7. Michigan
    8. Minnesota
    9. New Jersey
    10. New York
    11. North Dakota
    12. Oregon
    13. Pennsylvania
    14. Texas
    15. Utah

If your state requires PIP coverage, then you can count on your insurance policy to cover your expenses in an accident — even if another driver was at fault — unless certain monetary or verbal “tort thresholds” are met. That means either the resulting expenses would exceed a specific amount or you’d have to suffer a specific type of injury before being able to file a lawsuit. All these rules and regulations vary from state to state, so it’s important to know the laws where you live (check the Department of Motor Vehicles website for more info on the requirements in your neck of the woods).

The Coverage Stuff

When it comes to how much coverage you really need, well, as with a lot of other insurance scenarios, it depends. The cost of your policy will depend on your coverage limit and deductible, as well as your location, age, and other factors. Determining how much you need and can afford takes some personalized planning, so it’s always best to work with a skilled insurance agent who can walk you through the process (you can reach ours at 1.888.242.5204).

One of the biggest things to consider when looking into MedPay is your health insurance. If your health insurance will provide adequate coverage for injuries you suffer after a car accident, and MedPay isn’t required in your state, then you may not need it. If you health insurance does not cover injuries results from car accidents, it’s a good idea to buy medical payments coverage.

On the other end of the spectrum, often times PIP can work in conjunction with your health insurance coverage. To do so, you have to set your health insurance as your primary form of injury coverage after an accident. Which means: your health insurance benefits will pay your medical costs in the event of a car accident that causes you injury. Your Personal Injury Protection coverage would then help with expenses that exceed your health insurance limits. Be sure to consult with your health insurance and car insurance providers before making any decisions.

Remember both MedPay and PIP cover medical bills after an auto accident, but MedPay does not include coverage for lost wages, rehab or other essential services like PIP does. So, if you’re required to have PIP, MedPay may be overkill. However if your state’s limit on PIP is low, MedPay coverage could be a beneficial supplement.

Still Have Questions?

If you find all this info confusing, you’re far from alone. Insurance can be a tough topic to navigate, which is why Metromile offers a comprehensive Help Center to address all the most common frequently asked questions on coverage types, claims, billing, and much, much more. And if your question isn’t answered there, you can get direct, customized guidance from one of Metromile’s licensed agents. Whether you’re just signing up for a new policy, switching providers, or thinking of tacking on a new type of coverage, Metromile’s there to take the guesswork out of the equation. Get a free quote today or call 1.888.242.5204 to talk it out.

Michelle Konstantinovsky is a San Francisco-based journalist/writer/editor and UC Berkeley Graduate School of Journalism alumna. She’s written extensively on health, body image, entertainment, lifestyle, design, and tech for outlets like Cosmopolitan, Harper’s Bazaar, Marie Claire, Teen Vogue, O: The Oprah Magazine, Seventeen, and a whole lot more. She’s also a contributing editor at Fitbit and the social media director at California Home + Design Magazine. She is an avid admirer of shiny objects, manatees, and preteen entertainment.