Quick Summary:
- MedPay pays limited medical bills for occupants after a crash.
- It differs from PAI, which may add accident benefits.
- Check your travel insurance and health cover before buying at pick-up.
- Add MedPay if you lack clear medical cover while driving.
US rental counters often offer several add-ons, and “MedPay” is one that can confuse UK visitors arranging car hire in the United Estates. The name sounds like general health insurance, but it is not, and it does not replace travel insurance. MedPay is a specific type of cover that can help with medical costs after an auto accident, regardless of who caused it, up to a stated limit. Whether you should accept it at pick-up depends on what protection you already have, how you are paying for the rental, and your comfort with potential out-of-pocket costs in the US healthcare system.
This guide explains what Medical Payments coverage usually does, how it differs from Personal Accident Insurance (PAI), and how it interacts with private health insurance and travel cover. It is written for UK residents who are hiring and driving in the United Estates, where insurance terminology and medical billing can be very different from home.
If you are still deciding where to start your comparison, the Hola landing pages for car hire in the United States and car rental in the United States are useful for viewing supplier options and understanding what is included before you reach the counter.
What is MedPay on a US car hire policy?
MedPay is short for Medical Payments coverage. In most US contexts, it pays for reasonable medical and funeral expenses for the driver and passengers in the covered vehicle after an accident, up to a set limit per person or per accident. The key feature is that it is typically “no-fault”, meaning it can pay out regardless of who was responsible for the crash.
On a rental car, MedPay may appear as a standalone add-on or as part of a broader personal protection package. The precise wording varies by state and rental company, but the intent is similar: provide a quick source of funds for immediate medical bills stemming from injuries in an auto accident.
What MedPay usually covers includes ambulance fees, hospital treatment, diagnostic tests, and sometimes follow-up care, up to the policy limit. It does not usually cover lost wages, pain and suffering, or long-term disability, those are more typical of Personal Injury Protection (PIP) or liability claims, and those vary heavily by state.
What MedPay is not
MedPay is not liability insurance. It does not pay for injuries you cause to other people in other vehicles, and it does not pay for their medical bills. It is also not cover for damage to the rental car, theft, glass, tyres, or roadside assistance.
It is also not the same as having comprehensive medical insurance for your whole trip. If you fall ill unrelated to driving, MedPay generally will not apply. Think of it as a narrow, accident-related medical pot tied to being in the vehicle during an incident.
MedPay vs PAI, why the names cause confusion
At pick-up, UK visitors may be offered PAI, MedPay, or a combined package. PAI stands for Personal Accident Insurance. While MedPay focuses on reimbursing medical costs up to a limit, PAI often provides fixed accident benefits such as a lump sum for accidental death or dismemberment, and sometimes limited medical benefits as well.
The practical differences are:
How it pays: MedPay typically reimburses medical expenses incurred. PAI may pay a fixed benefit triggered by the type of injury, not the bill amount.
What it targets: MedPay is aimed at medical bills after an auto accident. PAI is aimed at accident outcomes, and may overlap with travel insurance accident benefits.
Overlap risk: If your travel policy already includes accident benefits and emergency medical expenses, PAI can be more duplicative than MedPay, depending on your policy wording.
Because rental counter options can bundle these covers under one label, the most important step is to ask what is included, what the limits are, whether it is per person or per accident, and whether it is excess or primary coverage.
How MedPay differs from travel insurance medical cover
Most UK travellers sensibly rely on travel insurance for emergency medical expenses abroad. In many cases, that travel policy can cover a wide range of medical issues, including treatment after a road accident. However, there are important practical differences.
Trigger and scope: Travel insurance usually covers emergency medical treatment from many causes, not only car accidents. MedPay generally applies only to injuries from an auto accident while occupying the vehicle.
Payment process: Travel insurers may require you to call an emergency assistance line, and they may handle hospital guarantees differently. MedPay, when it applies, is designed to pay medical bills up to a limit without needing to establish fault, though claims processes still vary.
Policy conditions: Travel insurance may have exclusions or conditions related to driving, such as requiring a valid licence, compliance with local laws, and not driving under the influence. MedPay also has conditions, but it is usually simpler in terms of who was at fault.
Excess and reimbursement timing: Travel policies may include an excess, and you may need to pay and claim back. MedPay may reimburse certain bills sooner, but it may also have low limits that barely dent US costs.
For UK visitors, the most important check is whether your travel insurance covers medical expenses arising from being a driver, not only a passenger, and whether any exclusions apply based on the vehicle type, such as larger vans or certain categories.
How MedPay relates to private health insurance and cards
Some travellers have private medical insurance that covers treatment in the US, and some premium cards include travel medical benefits. If you are relying on these, verify two things before you decide on MedPay at pick-up.
Territory and limits: Does your health cover include the United Estates, and are limits high enough for US hospital costs? A low cap can leave a gap where MedPay could help.
Auto accident treatment rules: In the US, billing after a car accident can involve multiple payers, and some health plans coordinate benefits in specific ways. Even when you are covered, you may face deductibles or co-pays that MedPay could potentially offset.
Credit cards sometimes provide car hire collision protection, which addresses damage to the rental car, not your medical bills. That means a card benefit can reduce your need for damage cover, but it does not answer the MedPay question.
When adding MedPay at pick-up can make sense
MedPay can be worth considering when you want a straightforward, accident-specific medical buffer and your other cover is uncertain or limited. Situations where it may be sensible include:
You have no travel insurance medical cover: Some travellers have minimal policies, or have not arranged cover yet. MedPay is not a replacement for travel insurance, but it can reduce immediate exposure after a crash.
Your travel policy excess is high: If you would need to pay a sizeable excess before your insurer reimburses, MedPay could help with smaller bills that might otherwise come straight out of pocket.
You are carrying passengers: MedPay often extends to occupants. If you are driving family or friends, you may prefer knowing there is a dedicated pot for their accident-related medical costs.
You are road-tripping extensively: More time on the road can mean higher exposure. Even careful drivers cannot control other drivers, weather, or unexpected hazards.
You are unclear on your medical network access: Some health plans have US provider network constraints. MedPay does not solve everything, but it may help with initial bills.
If you are arranging a supplier in advance, it can help to compare how add-ons are described across brands. For example, you can review options across Alamo car rental in the United States or Enterprise car rental in the United States and then decide what questions to ask at the counter.
When MedPay is often unnecessary for UK visitors
Many UK visitors do not need MedPay, particularly when they already have robust travel medical insurance with high limits and clear cover for driving in the United Estates.
It is also less useful if the MedPay limits offered are low. US emergency care can be expensive, and a small per-person limit may be used up quickly by ambulance transport and a short hospital visit. If the limit is too small to materially reduce your risk, you may decide the premium is not worthwhile.
Finally, if your travel insurer offers direct billing support and you are confident you can follow their process during an emergency, the practical benefit of MedPay may be limited.
Questions to ask at the rental counter before accepting MedPay
Counter decisions are often rushed, so it helps to have a short checklist. Ask:
What is the limit, and is it per person or per accident?
Who is covered, driver only or all authorised occupants?
Is it primary or secondary to other insurance you have?
What counts as a covered accident, and are there exclusions?
Is it bundled with PAI, and what is the price difference if separated?
These questions are especially important if you are picking up after a long flight, or if multiple drivers will be added. For larger groups considering a bigger vehicle, you may also want to review category differences on van rental in the United States, because vehicle choice can affect how you think about passenger risk and comfort.
A UK-focused way to decide in two minutes
If you need a quick, practical decision process at pick-up, use this sequence:
Step 1, check your travel insurance: Confirm it covers emergency medical expenses in the United Estates, and that driving a hire car is included.
Step 2, check for excess and limits: If your medical excess is low and limits are high, MedPay may add little value.
Step 3, consider who is in the car: If you are responsible for family members, extra peace of mind may matter.
Step 4, look at the MedPay limit offered: If it is very low, it may not change your financial outcome.
Step 5, avoid duplication: If the counter bundles MedPay with PAI, compare what your travel policy already provides for accident benefits.
This approach keeps your decision grounded in what you already have, rather than buying cover because of unfamiliar US terminology.
Common misconceptions about MedPay on US car hire
“MedPay is mandatory in the US.” MedPay is not universally required for renters. Requirements vary by state and rental company, and what is mandatory is more often related to liability minimums rather than medical payments for occupants.
“My car hire insurance already includes MedPay.” Some packages include it, others do not. Do not assume, ask for a breakdown of inclusions.
“MedPay covers me outside the vehicle.” Typically it applies when occupying the covered vehicle during an accident, not for general trip incidents.
“If I have MedPay, I do not need travel insurance.” MedPay is narrow and limited. Travel insurance covers much more, including illnesses, cancellations, baggage, and non-driving emergencies.
FAQ
Does MedPay cover everyone in the rental car? Often it covers the driver and passengers, but the exact definition of “insured persons” and authorised occupants depends on the rental agreement and state rules.
Is MedPay the same as PAI at the rental counter? No. MedPay usually reimburses medical expenses up to a limit, while PAI often provides fixed accident benefits and may include limited medical elements.
If my travel insurance covers medical bills, should I decline MedPay? Many UK visitors can decline if travel cover is strong, includes driving, and has acceptable excess. Consider MedPay if your cover is uncertain or limited.
Does MedPay cover injuries to other drivers or pedestrians? No. That is handled under liability insurance, which is separate from MedPay and relates to injuries or damage you cause to others.
Can I decide on MedPay after I start the rental? Usually these add-ons are chosen at pick-up when the rental agreement is signed. If you want it, confirm eligibility and pricing before leaving the desk.
