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Do I Need Pip If I Have Medicare

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Michigan PIP Coverage: Should I Opt Out If I Have Medicare? | Attorney Christopher Hunter

Michigans new no-fault law means drivers have more options for personal injury protection coverage, also known as PIP benefits. PIP covers medical bills from injuries sustained in an auto accident, as well as rehabilitation costs, lost wages, attendant care and other expenses. While personal injury protection has always been mandatory in Michigan, the new reform means you have the freedom to select a PIP coverage that best represents your needs and budget. Here are the six choices:

Does Medicare Cover Auto Accident Injuries In Michigan

Yes, under certain circumstances, Medicare will cover auto accident-related injuries in Michigan. But unlike No-Fault auto insurance, it will want to be reimbursed and it will not cover all of the vital medical care services that a car accident victim needs.

The interplay between Medicare and No-Fault auto insurance for car accident victims has always been complicated. Frankly, even most auto accident lawyers do not understand this area of law.

But with the new , it is more important than ever for you to understand what Medicare covers for auto accidents, the limitations of its coverage versus being covered under No-Fault insurance, and how selecting lower PIP cap amounts after July 1, 2020 will impact you if you are injured in a car accident.

What Coverage Options Are Available Tomedicare Recipients

A variety of medical coverage options are available to Medicare recipients under the new No-Fault law. They may keep their previous unlimited Personal Injury Protection medical coverage. Or, they can choose one of the limited PIP medical coverage options of $500,000 or $250,000. Additionally, policy holders enrolled in Medicare Parts A and B can opt out of PIP medical coverage entirely. To opt out, the policy holders spouse and any resident relatives covered by the policy must have their own qualified health coverage that covers auto accident injuries.

Qualified health coverage includes enrollment in both Medicare Parts A and B, or a health care plan that does not exclude or limit coverage for accident-related injuries.

This can include private health insurance or a different Michigan No-Fault policy with PIP medical coverage. Furthermore, the annual individual deductible for the health care plan must be $6,000 or less.

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What Happens If I Am In A Car Accident That Wasnt My Fault

Florida is a no-fault state, meaning that every driver is required to have PIP insurance under Florida Statute 627.7407. This statute dictates that your PIP must cover you for a minimum of $10,000. If a person has been in an accident and wishes to file a lawsuit against another party to cover damages greater than $10,000, then the individual is required to first make a claim against their own insurance company. This is the case regardless of who was at fault for the accident.

If you file a PIP claim and the damages resulting from your accident exceed your PIP coverage, then you might choose to file a claim against your other insurance policies if you have health insurance or against another party. If you have been involved in a car accident that wasnt entirely your fault, then you could be eligible to claim compensation from the insurance company of the other driver, for example.

In the State of Florida, you can sue a driver who caused a car accident if you suffered a serious injury as a result of the crash. This applies to the following injuries:

How Does Medicare Affect Car Accident Settlements In Michigan

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If Medicare covers auto accident-related injuries that Michigan No-Fault insurance should have paid, then they will seek reimbursement for its conditional payments through a lien on the pain and suffering portion of any car accident settlement that the victim obtains in his or her case.

Additionally, once the No-Fault PIP medical benefits coverage levels become available in policies issued or renewed after July 1, 2020, its possible that Medicare may seek reimbursement of its conditional payments through a lien on a victims third-party tort recovery for excess medical benefits.

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How Can I Get A Qhc Letter

There are several ways you can request a QHC letter.

  • You can log in to your online member account to see if you have a QHC letter to download. Once logged in, navigate to the QHC letter in the Proof of Insurance section at the bottom of the page.
  • You can call the number on the back of your member ID card.
  • If you don’t see a QHC letter online or are unable to get one through calling the number on the back of your card, you can reach out to your employer to request the letter.

What Happens If A Senior Chooses Lower Limits

Seniors that choose lower limits and exhaust their PIP Medical limits in auto accidents and have no other medical coverage. Medicare will pay for Medicare-covered services. Enrollees will remain responsible for coinsurances, copayments, and deductibles, and any services that Medicare does not cover.

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Do I Need Pip Coverage If I Have Health Insurance

Home » Frequently Asked Questions » Do I Need PIP Coverage If I Have Health Insurance?

Healthcare can be extremely expensive in the United States, and people often wonder whether they need Personal Injury Protection as well as health insurance. The short answer is yes. You do need PIP coverage regardless of whether you already have regular health insurance.

Personal Injury Protection is a type of insurance that pays for medical and rehabilitative costs for you or your passengers in the case that you are involved in a car accident. PIP is also known as no-fault insurance and is required by law in all no-fault states, including Florida.

In Florida, every vehicle and vehicle owner much carry a minimum of $10,000 PIP coverage on their auto insurance policy. This law is in place to protect drivers. It is a sad reality that car crashes are all too common in the State of Florida, where the National Safety Council estimates that in 2019 alone, there were 3.1 million car crashes, where those accidents led to 4.5 million medically consulted injuries.

Personal Injury Protection can cover the car accident injuries of you and your passengers, regardless of who was to blame for the accident. This type of insurance is a legal requirement as part of Floridas no-fault insurance laws. This means that it would be illegal to drive in Florida without PIP, even if you have another type of health insurance.

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Medicare And Michigan Auto Insurance Coverage

Michigan PIP Insurance: The Major Change In No-Fault Insurance

Michigan has long had the reputation of being a horrible state to purchase car insurance in. Horrible meaning expensive. And, that reputation has been well-earned as we have unique auto insurance laws that impact us all.

Were going to limit our conversation here to essentially the medical portion of our auto coverage in Michigan . Well be doing that because, as you know, were here to help people with their transition to the Medicare medical system thus the tie-in.

So, we have this system called no-fault in Michigan. What this means is that your coverage is a type of car insurance that helps pay for your and your passengers medical bills if youre injured in a car accident, regardless of who caused the accident.

Long story short, when you are on Medicare and are injured in a car accident, Medicare is not your Primary Insurance. Your primary carrier is your auto insurance company. Thus, the higher rates that you pay for this increased exposure to the auto carrier.

No-fault insurance is also called personal injury protection, or PIP insurance.

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Pros Of Medicare Advantage

Lower monthly premiums // The national average premium for Medicare Advantage plans in 2020 is $23/month according to the Centers for Medicare & Medicaid Services . However, as we mentioned before, there are many Medicare Advantage plans across the country that are $0/month.

Single Insurance Plan // Medicare Advantage plans are often seen as a more convenient choice for Medicare coverage. The bundled approach of Medicare Advantage plans means that you can use the same insurance coverage/card at both the doctors and the pharmacy. Although this is often seen as a benefit to Medicare Advantage coverage, we highly recommend that you do not make this the reason you do, or do not choose one option over the other.

Additional Benefits // Unlike with Medigap plans, Medicare Advantage plans commonly include dental/vision/hearing coverage, gym memberships and prescription drug coverage at no added cost.

Limited discrimination for pre-existing conditions // The only medical disqualifier for enrolling in a new Medicare Advantage plan is if you have end-stage renal disease . For individuals with many ailments, this means they can change Medicare Advantage plans during the proper enrollment periods as long as they do not have ESRD.

Commercial And Individual Members

In general, if you are under an employer-sponsored or Individual health plan that covers auto injuries and has an individual deductible of $6,000 or less, your health coverage qualifies and you can opt out of PIP. Self-funded employers retain the right to handle/exclude/coordinate coverage for auto injuries.

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What Does Pip Insurance Not Cover

  • Damage to your car.
  • Damage to other peoples property.
  • Injuries to other drivers involved in an accident.
  • Injuries from accidents that occur while a covered driver is using their car to make money.
  • Injuries from accidents that are caused intentionally.
  • Injuries resulting from accidents that occur while the covered driver is committing a crime, such as fleeing the police.
  • Injuries that were caused by an uninsured car owned by you or an immediate family member.

Options In Between Unlimited And Opting Out

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There are also other PIP options that you will have. You may choose $250,000 for example which is Option 4 See the form here.

If you chose Option 4, for example, your medical limit would become $250,000 and you would also have the ability to purchase a rider for excess attendant care coverage. Weve not seen the rates for any of the riders at this point but you would see a reduction of premium for your PIP coverage being reduced from unlimited to $250,000.

Notes the following information cited from the Michigan Department of Insurance & Financial Services website:

The Benefits of the Change.

The premium reductions are as follows: All PIP limits apply to PIP medical. The full PIP premium must be reduced by the amount required in MCL 500.2111f. Companies can only charge the portion of MCCA premium that is from a deficiency, if applicable.


So, look at your current auto insurance bill, see the PIP premium related and note that the anticipated premium reductions will be on that portion of your bill. Review this part with your auto insurance agent to see what your ultimate premium AND coverage reduction will result in for you.

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Medicare Qualifications For New Pip Plans

In order to qualify for PIP benefits, seniors must be enrolled in Medicare Parts A and B. Your spouse or other household family members must also qualify by having Medicare or health insurance providing benefits during an automobile accident.

For enrollees who opt-out of this protection, Medicare will pay for all approved services in the event of an accident if you have no other insurance plans. In these cases, the enrollee will be responsible for regular Medicare coinsurances, copayments, and deductibles. There are also differences in coverages that Medicare will not pay, including transportation for doctor visits, case management services, and long-term custodial care, which are included in your auto insurance PIP coverage.

Be sure to read the fine print for all the options offered with medical and auto insurance plans. Before enrolling in a plan, talk with your auto insurance advisor.

MI auto and medical insurance reform is underway to help provide drivers with more personal injury protection options to get lower pricing. Contact the experts at CIA Insurance & Risk Management today to gain a clearer understanding of these changes in Michigan.

Q: What Happens If I Use All Of My Pip Benefits

A: Like a credit card, your PIP coverage does have a limit. Once youve maxed out your PIP coverage, you are responsible for your own medical bills. In some cases, health insurance will cover some of these costs. However, if you have reached the end of your PIP coverage you should contact an auto accident attorney to explore other options. Oftentimes the at-fault driver may have Bodily Injury Liability coverage within their insurance policy to help cover a victims medical costs.

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Michigan Personal Injury Protection Choices

Medicare enrollees can elect to keep the unlimited coverages on their auto policies. If seniors keep unlimited medical coverages, the auto insurer will pay for the services that Medicare would not cover. Seniors can purchase lower than unlimited levels of PIP medical coverage: $250,000 or $500,000 per person per accident of coverage.

How Are Medicare Services Different From Michigans No

Choosing Personal Injury Protection (PIP) Coverage

Unlimited lifetime PIP medical coverage pays for all necessary and reasonable accident-related expenses. As long as medical treatment is needed to ensure recovery, there are no limits on the duration of coverage.In contrast, Medicare only pays for specific and limited services. If a patient requires more rehabilitative or occupational therapy than Medicare allows, then the patient will have to pay for those additional sessions.

Below are some of the medical services that are not covered by Medicare:

  • Transportation to and from medical appointments
  • Nursing home care
  • Home and vehicle modifications for recovering patients

Medicare offers the following services on a limited basis:

  • Intermittent skilled nursing facility care
  • Long-term rehabilitation therapy
  • Speech and language therapy

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Does Medicare Cover Auto Accident Injuries Under The New No

Yes. According to Insurance Bulletin 2020-05-INS, which the Michigan Insurance Commissioner issued just this past Monday, February 10, 2020. In the Bulletin, the Insurance Commissioner addresses the following questions regarding Medicare and No-Fault in Michigan:

  • Will Medicare cover auto accident-related injuries for a crash victim who opted out of No-Fault PIP medical benefits coverage under MCL 500.3107d?
  • Will Medicare cover auto accident-related injuries for a crash victim who has reached his or her selected coverage limit for No-Fault PIP medical benefits under MCL 500.3107c?

To both questions, the Insurance Commissioner answered yes:

  • Medicare will pay for Medicare-covered services to enrollees who opt out of PIP medical benefits, are injured in an automobile accident, and have no other available coverage.
  • The new law also allows Medicare enrollees to purchase lower than unlimited levels of PIP medical coverage: $500,000 or $250,000 per person per accident. If a Medicare enrollee is injured in an accident and exhausts his or her PIP medical limits, and has no other available coverage, Medicare will pay for Medicare-covered services . . .

It will be interesting to see how the following observations by the Michigan Supreme Court in John Hancock Property & Casualty Insurance v. Blue Cross Blue Shield play out under the provisions of the new No-Fault law:

Pip Insurance Requirements By State

Twelve states, shown on the map below, require all drivers to carry at least a minimum amount of PIP insurance.

$250 per week or 85% of lost income $20 per day for services

As of July 2021

*Pennsylvania law requires drivers to carry medical benefits coverage, not PIP specifically

In addition to the states where PIP is mandatory, seven states and the District of Columbia require insurers to offer PIP but allow drivers to reject the coverage. Specifically, PIP is optional in Arkansas, Kentucky, Maryland, South Dakota, Texas, Virginia, and Washington.

Learn more about PIP insurance requirements by state.

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Q: Why Is My Insurance Paying The Bills When Another Driver Was At

A: Due to Florida being a no-fault state, your mandatory PIP coverage is meant to pay your bills, even if another driver was at fault. However, this doesnt mean you have to shoulder all costs on your own. Filing a claim with an at-fault driver means you must prove liability. Essentially, neither the at-fault driver nor their insurance company is required to pay for your medical expenses until youve proven liability.

At Weinstein Legal, we understand that taking on that task alone can be intimidating. Thats why our dedicated team of attorneys will work with you to fight for the compensation you deserve. If you have questions regarding a claim, check out our personal injury lawsuit timeline.

If you or someone you love has recently been involved in an auto accident and is facing difficulties with their PIP coverage, contact the office of Weinstein Legal. For a free and confidential consultation, enter your details in the form to your right. We look forward to hearing from you soon.

Billing Medicare And Medicaid For Patients With Injury Claims

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When your injured patient is covered by Medicare or Medicaid , you may be inclined to bill another paying source which might be available. It is important to be aware of the rules effecting who you may bill, bow much you may bill and when you may bill.

This article gives an overview of the potential payers for treatment of accident-related injuries and reviews sonic of the rules involved when your patient has Medicare or Medicaid coverage. You may want to pass this article along to your billing office manager.

The first payment source when billing for accident-related injuries is Personal Injury Protection coverage on the car your patient was in at the time of the accident. As explained in our Summer 1996 Medical Legal Journal , all auto insurance policies in Oregon must provide a minimum of $10,000 no-fault medical coverage for up to one year after the accident. For more details on PIP, see that article or call our office and ask for Julia Lincharger-Taylor.

If PIP benefits are not available or have expired, your next option is to Bill your patients health insurance, which may include Medicare or Medicaid. Some medical providers are reluctant to hill the government programs, since they pay on a reduced fee schedule, and their payment is final. It seems better economic sense to wait to get paid in full by the at fault insurance carrier.



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