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Should Senior Citizens Opt Out Of PIP Coverage – Medicare Vs PIP

| Jul 23, 2020 | No Fault Insurance Claims, Personal Injury Law

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:

BENEFITS
AUTO NO-FAULT
MEDICARE

Post‑acute Care/Sub‑acute Rehabilitation
Yes 100% as longas needed
Limited 100 days at80%

Long term Care/Custodial Care
Yes 24/7 if needed
Not Covered

Residential Treatment Programs
Yes
Not Covered

Case Management Services
Yes
Not Covered

Attendant Care (assistance w/care and supervision) Unlimited in duration and number of hours
Yes
Limited home health aide 2 or 3/wk for 4/hr during recovery

Guardianship or Conservators
Yes
Not Covered

Transportation Services (medical)
Yes
Not Covered

Physical, speech, Outpatient Therapy (Unlimited)
Yes
Limited Covers 80%

Chiropractic Treatment
Yes
Limited coverage for spinal subluxations. Does not cover tests, x-rays and acupuncture

Medications
Yes
Coverage gap and limitations under Part D

Dental
Yes
Not covered (Medicare Advantage Plans provide some coverage)

Vision
Yes
Limited coverage for age related macular degeneration. Routine eye care not covered.

Office Visits
Yes
Variable

Durable Medical Equipment
Yes
Limited Covers 80%

Massage Therapy
Yes
Not Covered

Home Modifications for Accessbility
Yes
Limited

Vehicle Modification
Yes
Not Covered

Specialty Assistive Devices
Yes
Limited

Wage Loss – if senior is still working
Yes – Up to 3 Years
Not 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 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.

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