Should Senior Citizens Opt Out of PIP Coverage – Medicare vs PIP

Under the new law, as of July 2, 2020, senior citizens will have the option to opt out from no-fault allowable expense PIP benefits if they meet the following conditions:

1) The person is covered under Part A and B of Medicare;

2) The person's spouse and any relative residing in the household has Medicare or a qualified health coverage, or has no-fault PIP coverage under a separate policy.

We recommend senior citizens review the following chart to understand what benefits are not available under Medicare if you decide to opt out of PIP coverage:

BENEFITSAUTO NO-FAULTMEDICAREPost-acute Care/Sub-acute RehabilitationYes - 100% as long as neededLimited - 100 days at 80%Long-term Care/Custodial CareYes - 24/7 if neededNot CoveredResidential Treatment ProgramsYesNot CoveredCase Management ServicesYesNot CoveredAttendant Care (assistance w/care and supervision) Unlimited in duration and number of hoursYesLimited home health aide 2 or 3/wk for 4/hr during recoveryGuardianship or ConservatorsYesNot CoveredTransportation Services (medical)YesNot CoveredPhysical, Speech, Outpatient Therapy (Unlimited)YesLimited - Covers 80%Chiropractic TreatmentYesLimited coverage for spinal subluxations. Does not cover tests, x-rays and acupunctureMedicationsYesCoverage gap and limitations under Part DDentalYesNot covered (Medicare Advantage Plans provide some coverage)VisionYesLimited coverage for age-related macular degeneration. Routine eye care not covered.Office VisitsYesVariableDurable Medical EquipmentYesLimited - Covers 80%Massage TherapyYesNot CoveredHome Modifications for AccessibilityYesLimitedVehicle ModificationYesNot CoveredSpecialty Assistive DevicesYesLimitedWage Loss – if senior is still workingYes – Up to 3 YearsNot Covered

* 2019 limits according to medicare.gov

Related Issues to Consider Regarding if Senior Citizens Should Opt Out of Personal Injury Coverage

Important to note: If a senior citizen receives a settlement from an accident claim, Medicare is entitled to recover the cost of any medical expenses paid to the claimant, which may effectively eliminate your right to a financial recovery against the at-fault driver.

It is best to speak with a knowledgeable personal injury lawyer if you have questions regarding Michigan's new No-Fault Law to identify which policy will provide the best coverage for your unique situation.

If you are an accident victim and have been injured, Logeman, Iafrate & Logeman, P.C., is a personal injury law firm that can help. We have been helping accident victims recover the compensation they need to rebuild their lives and take care of their families for over 45 years. Call today for a free consultation.

Can senior citizens in Michigan opt out of PIP coverage?

Yes, as of July 2, 2020, senior citizens can opt out of no-fault PIP benefits if they have Medicare Parts A and B, and their spouse and household relatives have Medicare, qualified health coverage, or separate PIP coverage.

What are the main differences between Medicare and auto no-fault PIP coverage?

Auto no-fault PIP provides unlimited coverage for many services including 24/7 long-term care, unlimited attendant care, transportation services, and vehicle modifications. Medicare has significant limitations, covering only 100 days of post-acute care at 80%, limited home health aide services, and doesn't cover custodial care, transportation, or vehicle modifications at all.

Does Medicare cover long-term care after an auto accident?

No, Medicare does not cover long-term custodial care. Auto no-fault PIP coverage provides 24/7 long-term care if needed, which is a critical benefit for seniors who suffer serious injuries in car accidents.

What happens if I receive a settlement and have Medicare?

If a senior citizen receives a settlement from an accident claim, Medicare is entitled to recover the cost of any medical expenses it paid to the claimant. This may effectively eliminate your right to a financial recovery against the at-fault driver.

Should I consult with a lawyer before opting out of PIP coverage?

Yes, it's best to speak with a knowledgeable personal injury lawyer about Michigan's No-Fault Law to identify which policy will provide the best coverage for your unique situation before making this important decision.