If Your Or Your Spouses Employer Has 20 Or More Employees Then The Group Health Plan Pays First And Medicare Pays Second
didnât pay all of your bill, the doctor or
should send the bill to Medicare for secondary payment. Medicare will pay based on what the group health plan paid, what the group health plan allowed, and what the doctor or health care provider charged on the claim. Youâll have to pay any costs Medicare or the group health plan doesnât cover.
Employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer employees under 65. If the employer offers coverage to spouses, they must offer the same coverage to spouses 65 and older that they offer to spouses under 65.
How Pip Insurance Works
Most states that require PIP are no-fault states, which require each person to cover their own medical expenses if theyre injured in an accident, regardless of who is responsible. These states do not permit you to sue other drivers for compensation for your injuries unless they are severe.
The alternative to no fault insurance laws is a tort system for paying claims for medical expenses. In tort states, there are no restrictions on the right to sue. Two tort states also require drivers to carry PIP insurance. In the case of an accident in a tort state, PIP insurance provides immediate benefits to injured people in your vehicle, but it does not limit anyones right to sue the at-fault driver for damages.
Learn more about how PIP insurance works.
How Fehb Other Health Insurance Coordinate Benefits
Federal Employees Health Benefits program carriers are obligated to follow standard coordination of benefit rules established by the National Association of Insurance Commissioners in order to make sure that payments to providers and customers do not duplicate payments of other health benefits coverages the member may have.
OPM allows retired enrollees to suspend FEHB coverage to enroll in any one of the following programs if eligible, thus eliminating the FEHB premium: a Medicare HMO, Medicaid, Tricare, or CHAMPVA. OPM does not contribute to any applicable premiums. If the individual later wants to re-enroll in the FEHB program, generally they may do so only at the next open season unless they have involuntarily lost the other coverage.
The most common instances where OPM coordinates with other programs are the following:
Tricare and CHAMPVA. FEHB carriers coordinate Tricare /CHAMPVA benefits according to their statutes. Tricare is the health care program for eligible dependents of military persons and retirees of the military. CHAMPVA provides health coverage to disabled veterans and their eligible dependents. When Tricare or CHAMPVA and FEHB cover the enrollee, FEHB pays first.
Medicaid. When the enrollee has Medicaid and FEHB, FEHB pays first.
No-fault coverage. FEHB carriers coordinate the payment of medical and hospital costs under no-fault or other automobile insurance that pays benefits without regard to fault according to the NAIC guidelines.
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Does Medicare Cover Auto Accident Injuries
Medicare may help cover auto accident injuries, but Medicare may pay after your car insurance company.
If you are in a car accident and suffer injuries that are covered by your car insurance carrier, they may pay their share of your covered costs.
If the treatment for your injuries is also covered by Medicare, Medicare may help cover some of the remaining costs after your car insurance company pays first.
What Does Medicare Cover In An Auto Accident
Medicare : If you are on Medicare prior to a car accident , Medicare will pay for your car accident injury treatment much like private health insurance. If you receive Social Security Disability Insurance benefits, you may need to consider Medicares interests even if you have not received Medicare benefits.
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Has Medicaid Covered Auto Accident Injuries In Michigan Previously
Historically, Medicaid was not supposed to cover auto accident injuries in Michigan. Like Medicare, Medicaid is a secondary payer under federal law, meaning that it would not pay for a car accident victims medical care and treatment if a third-party such as No-Fault auto insurance has the legal liability to pay. 42 CFR § 433.138)
However, in the rare, unintended circumstance that Medicaid did end up covering auto accident injuries even though No-Fault insurance coverage was available Medicaid would always seek reimbursement from the car accident victim. 42 CFR § 433.139)
Typically, reimbursement involved Medicaids assertion of a lien on a car accident victims third-party tort recovery for pain and suffering compensation.
And, as I will discuss more below, reimbursement in the future may also include Medicaid liens on all excess medical and economic damages that a car accident victim can now claim in a car accident lawsuit in tort after July 1, 2020 when these provisions of the new auto law take effect. )
Does Medicare Cover Injuries After An Auto Accident
Now back to the lingering question: Will my Medicare coverage pay for my medical treatment and auto accident bills?
Every state has different laws regarding how car insurance and Medicare coverage work. In Florida, it is mandatory that all Florida drivers purchase Personal Injury Protection, or PIP, with their insurance policy. This is due to the Sunshine States no-fault rule, where regardless who is at fault in an accident, you always go through your own PIP insurance. PIP helps pay for a percentage of your medical bills up to $10,000 . Its a common assumption that drivers arent legally required to pay for damages they are at fault for because Florida is a No-Fault state, but that is not what it means. A No-Fault state just means that drivers involved in an accident must rely on their own auto insurance providers to pay for additional costs.
But what if your PIP is exhausted and you still have medical treatments and auto accident bills to pay for? This is when health insurance, including Medicare coverage, can supplement and help. Depending on your policy, it can help pay a percentage of bills much like PIP does.
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Who Is Responsible For Your Medical Bills In An Auto Accident In Michigan
Before we begin to understand who is responsible for paying your medical bills that resulted from a car accident, we have to consider the nuances of Michigan auto law. Michigan is a No-Fault state, which means the state allows any party involved in an auto accident cases to gain benefits from their insurance companies, no matter whose fault it was. If the accident involved negligent driving from the opposing end, please contact contact a Michigan auto accident attorney at Cochran, Kroll & Associates, P.C. who can support your claim and offer professional legal advice. More specifically, if negligence and irresponsible driving led to unforeseen injuries and suffering that put you or someone you know in the hospital. Before you know it, unwanted medical bills begin to pile up. A qualified Michigan car accident lawyer can help.
Why Adhering To Michigans Car Insurance Requirements Is Important
Even if the prices are higher than average, carrying car insurance in Michigan is required. Not all coverages are legally mandated, but adding coverage or increasing your current limits is recommended for most drivers in order to further protect assets. However, if youre worried about an increase in your premiums, it may be time to shop for cheaper coverage. The Zebra is a great place to from the nations top carriers.
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Does Medicaid Cover Auto Accident Injuries In Michigan
Medicaid, which provides health coverage to low-income families and individuals and many suffering from disabilities, is typically not tapped to pay for auto accidents in Michigan but there are rare cases where Medicaid does provide coverage.
One example is for those who choose a No-Fault medical benefits coverage level between $50,000 and $500,000. When coverage is extended, the reimbursement is likely to be drawn from the injured persons Medicaid. Under the states existing No-Fault law, individuals who choose the unlimited PIP option are unlikely to ever see their Medicaid impacted. Those with other PIP coverage limits might experience coverage specifics.
In addition, once a car accident victims medical bills reach his or her No-Fault PIP medical benefits coverage limit and No-Fault coverage ends, the law presumes Medicaid may serve as a resource for ongoing medical care.
One other factor to consider is that if Medicaid covers auto accident injuries for accident-related medical bills that No-Fault insurance had the legal liability to pay, reimbursement through a lien may be sought.
Does Health Insurance Pay For Auto Injuries
When we talk about car accidents , we are referring to coverage for bodily injuries that occur from being in a car accident and NOT damage to your car or another persons car . Health insurance plans will never cover standard auto insurance benefits which actually insure the car so we need to be clear on this.
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Michigan Auto Insurance Savings
Michigan Auto reform states that depending on your Personal Injury choice, you should see the following reductions.
- $500,000 PIP coverage option: 20% reduction
- $250,000 PIP coverage option: 35% reduction
- Opt-out of PIP coverage: Individuals with Medicare or qualified health insurance will receive a 100% reduction in portions of PIP. The MCCA reduces the fee to $0 for the 2021 year.
Find an Insurance Agent to Quote Michigans new Auto Rates.
Finally, to get a new reform quote, you can contact an agent at or click the highlighted link to have an agent call you with a Michigan Auto Reform quote to see what your savings will be. For more information on the other changes that will affect Michigan auto policies, go to our update on Michigan Auto Insurance Reform.
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.
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Cons Of Medicare Advantage
Limited Networks // Medicare Advantage plans commonly come in the form of HMOs and PPOs . If you have a Medicare Advantage plan you will typically have to healthcare providers in the plans contracted network, or you will likely have much higher out of pocket costs. Restricted networks place an increased burden on individuals that enjoy frequent travel, or anyone that wants unrestricted access to premier medical facilities nationwide .
Yearly contracts // Medicare Advantage plans are renewed on a year-to-year basis. Medicare Advantage plan benefits typically change every year, which can cause either negative or positive impacts for enrollees . Perhaps the biggest con to having a yearly contract is that your doctors are not under the same contract constraints. Doctors and even entire health systems can cease their contract with a Medicare Advantage plan at any time of the year. Meanwhile, enrollees in the plan do not have the same luxuries. If your doctor or hospital stops accepting a plan mid-year, you will have to find alternatives or pay higher out of network costs until you can make a change during an enrollment period.
Essentially, Medicare Advantage plans will take a more active role in your healthcare. Getting approval for certain higher-cost procedures can become a hassle at unfortunate times.
What Is Personal Injury Protection
Personal injury protection is a type of car insurance that covers expenses like medical bills, lost wages, or funeral costs. PIP covers you and your passengers when you are in a car accident, regardless of fault. PIP insurance, also known as no fault insurance, is required mostly in states with no-fault insurance laws.
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Optional Car Insurance Coverage In Michigan
Michigan law requires a number of different coverage types. However, most insurance carriers offer further coverage options that can be quite useful. Here is a list of some of the more common options available:
- Comprehensive: This coverage pays for damages to your vehicle that occur in non-collision circumstances. It covers perils such as theft and damage related to weather events.
- Collision: This coverage pays for damages to your vehicles that result from a collision with another vehicle or stationary object.
- Loan/Lease Payoff: Sometimes referred to as gap coverage, this coverage will pay the difference between what you owe on a loan and your vehicles . This can help in the event that you owe more than your car is actually worth.
- : If your car is unable to be driven, this coverage can help pay for a rental car until yours can be fixed.
- : Most insurance companies offer some type of roadside assistance that can help with flat tires, dead batteries, and other unexpected expenses.
- Uninsured/Underinsured Motorist Coverage: This coverage will help pay if you are in an accident in which an uninsured driver is at fault.
Changes For Michigan Drivers
The reformed Michigan no-fault insurance law lets Michigan drivers choose the Personal Injury Protection option that best meets their unique needs and budget. Previously, it was mandatory for drivers to carry unlimited PIP coverage. As of July 2, 2020, drivers can choose from six different PIP options:
Additionally, these changes went into effect July 2, 2020:
The following changes went into effect July 2, 2021:
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Liability Coverage Requirements In Michigan
is legally required in Michigan. It pays for bodily injuries and property damage of those that you harm in an at-fault accident. It also pays for the injured partys lost wages and pain and suffering. Your liability coverage never pays for your injuries or damages to your property.
With Michigan being a no-fault state, the liability coverage required on your policy mainly serves to provide coverage if you are involved in an at-fault accident out of state. However, it can also come into play inside state lines in extreme cases, such as if you cause death or permanent disability or disfigurement. It is important to note that property damage liability does not cover damage caused within the state of Michigan.
Does Medicare Part A And B Cover Auto Accident Injuries In Michigan
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.
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Medicaid Car Insurance: Everything You Need To Know
Low-income families in the United States can receive health care coverage from the federal Medicaid program. Each state manages its own program, which shares funding from the state and federal governments.
Low-income families in the United States can receive health care coverage from the federal Medicaid program. Each state manages its own program, which shares funding from the state and federal governments. While Medicaid car insurance does not exist, some policies may cover medical expenses the member incurs in an auto accident. However, this coverage will not pay for injuries suffered by passengers or damage to the memberâs vehicle. It also does not cover liability in an at-fault accident. If you have difficulty affording auto insurance, you may qualify for special programs that are available in certain states.
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What Are The Pip Medical Coverage Options For Medicaid Recipients
Michigan residents who are enrolled in Medicaid can choose PIP medical coverage with a $50,000 per person per accident limit.
To qualify for this option, the policy holders spouse and resident relatives must have their own qualified health care coverage that covers auto accident injuries. This coverage can be provided by Medicaid, private insurance or a separate No-Fault policy that includes PIP medical coverage.
If you are unsure of which Personal Injury Protection medical benefits are right for you and your family, consult a knowledgeable insurance agent.
And, if you or a loved one is injured in an accident, call us. Our experienced and compassionate legal team is ready to fight for your rights to the compensation you deserve.
Michigan No-Fault law is complicated, but finding the right accident lawyer is simple.
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