Given Michigan’s complex no-fault auto law, it can sometimes be difficult to understand who will pay your medical bills when you’re injured in a car accident. This article explains the difference between primary and supplemental medical coverage for auto insurance in Michigan, what is covered, and how Michigan drivers can ensure they are covered for any medical bills related to injuries sustained in an auto or truck accident.
Most people have so-called “coordinated” or “excessive” medical benefits on their auto insurance policies. This means that if you are injured in a car or truck accident, your health insurance should pay first, and then the car insurer is responsible for the balance under Michigan’s no-fault law.
It is also possible to include primary medical services in your insurance policy. Another term for this is Primary Medical PIP (Personal Injury Protection Benefits). This means that in the event of a car accident, the injured party will receive medical benefits from their car insurance company.
Coordinated coverage is cheaper than primary insurance because your car insurance assumes that in the event of a motor vehicle accident, they don’t have to pay first.
In some cases, however, the car insurer pays first. One such example is when the health insurance policy includes an automobile accident exclusion. This is an exclusion in the policy stating that the insurance company will not pay for auto accident treatment when Michigan no-fault coverage is in effect. Progressive no longer issues coordinated policies in Michigan. All of Progressive’s policies in Michigan are now primarily for medical expenses.
An even more common situation is when people lose their health insurance due to a layoff or termination and forget to tell their auto insurer that they no longer have health insurance. If this happens before an auto accident, the auto insurer will typically charge a higher medical deductible than if the health insurer had paid first. Most insurers charge anywhere from $0 to $300 for a medical deductible if the policy is set up correctly. When the insurance company ends up in a primary position, they generally increase the deductible to make up for the premium they would not have received if the policy had been drafted correctly. Some insurers now have options that include a $10,000 medical deductible, which of course we don’t recommend.
Additionally, Medicare and Medicaid traditionally should not be used for auto accidents because they are the payers of last resort. However, based on the 2019 no-fault reform, people with Medicare can opt out of no-fault medical and use Medicare instead. Similarly, those on Medicaid can opt-in for the minimum $50,000 no-fault medical coverage. Once that amount is depleted, they can begin billing their Medicaid for medical expenses.
As of the 2019 no-fault reform, the following levels of no-fault PIP health insurance are available:
A. $0 if you have Medicare or a qualifying health plan (ie, a health plan that covers medical expenses related to an automobile accident when no other coverage exists). We recommend that you check with your health insurance plan and/or an attorney before opting out.
B. $50,000 if you have Medicaid
E. Unlimited – under the original No-Fault Act
In any case, we recommend unlimited coverage. We strongly discourage opting out and the $50,000 option. The $250,000 and $500,000 options are better than the opt-out option, but in the event of a catastrophic accident, you can exhaust either or both of these coverages in a very short time. In addition, your treatment options are better, especially if you use the services of Primary PIP Medical.
SITUATIONS WHERE MICHIGAN DRIVERS SHOULD CHOOSE PIP PRIMARY MEDICAL BENEFITS
There are several situations in which it is beneficial for people to take advantage of medical benefits from their auto insurance by opting for primary PIP medical coverage. While it may be a bit more expensive, the positives far outweigh the slightly higher cost.
Here are some examples of when people with PIP primary medical insurance benefits are better off:
1. Auto Accident Exclusions.
If you have any type of auto accident exclusion in your health insurance plan, you should choose primary health insurance for your auto no-fault insurance. To find out if you have an automobile accident exclusion, you should contact your health insurance company and request a copy of the “Summary Plan Description” or the plan itself. Check this with your insurance agent as well.
2. Beware of self-funded ERISA plans.
If your health insurance is a self-funded ERISA plan, you should choose primary health insurance for your auto no-fault insurance. Large companies often have self-funded plans where the number of employees is large enough that employers can bear the financial risk themselves. With such plans, the company appoints the health insurer (e.g. Blue Cross Blue Shield) as administrator, but the money for the costs is paid out of the company’s assets and not the health insurer. These plans may assert a state lien against your auto accident negligence claim (ie, your indemnity claim against the at-fault driver after an auto accident). Keep in mind that this area of law is ever-changing and highly competitive between personal injury attorneys and consumer rights organizations on the one hand, and attorneys representing the ERISA plans on the other. The best way to avoid the problem is to choose primary medical care for your auto no-fault insurance.
To find out if your health insurance plan is a self-funded ERISA plan, you should contact your health insurer and request a copy of the “Plan Summary” or the actual plan. This will help you review and establish your responsibilities regarding refunds and replacements.
3. If you have an HMO.
HMOs can be very restrictive and often result in delayed medical treatment. Choosing primary care PIP means you don’t have to treat within the HMO and can significantly speed up your treatment and improve your choice of providers.
4. Important Medicare and Medicaid Warning If You Are Injured in an Auto Accident and Have Michigan No-Fault Insurance:
If you have Medicare, Medicaid, Veterans Administration Benefits, or a county health plan, you should have a primary medical PIP on your no-fault auto insurance. This helps avoid the “super liens” that government benefit providers may otherwise have against your car negligence case (i.e. the case for your personal injury and pain and suffering you suffered against the at-fault driver driving your vehicle). caused the accident). .
Disclaimer: Every effort has been made to ensure the accuracy of this publication at the time of writing. It is not intended to provide legal advice or to suggest a guaranteed result, as individual situations may differ and the law may have changed since publication. Readers considering legal action should consult an experienced attorney to understand applicable laws and how they may affect a case. For specific technical or legal advice on the information provided and related matters, please contact the author.