Can I Opt Out of Personal Injury Protection (PIP) If I Have Medicare?

Michigan lets drivers pick a PIP medical limit. People with Medicare Parts A and B, or a Medicare Advantage plan, can choose no PIP medical at all if the rest of the household also qualifies (MCL 500.3107d). That is Option 6 on the DIFS selection form. It is not the same thing as the $250,000-with-exclusions choice.

Opting out can cut the premium. It also means auto-accident care that PIP would have paid — attendant care, mileage, home modifications, long rehab — may land on Medicare’s narrower list, or on you. Talk to an insurance agent before you sign the form. If you are already hurt, talk to a car accident lawyer.

HOW DOES MICHIGAN NO-FAULT TREAT PIP MEDICAL?

You still need a No-Fault policy on a registrable motor vehicle. What changed in 2020 is the medical piece of PIP (MCL 500.3107c). DIFS lists six choices:

1. Unlimited PIP medical
2. $500,000 per person per accident
3. $250,000
4. $250,000, with named people excluded if they have qualifying non-Medicare health coverage
5. $50,000 — named insured on Medicaid, household covered
6. No PIP medical — named insured on Medicare A and B (or Advantage), household covered

Medicare recipients can still buy unlimited, $500,000 or $250,000. Option 4 is not “the same as $0 for Medicare.” Option 4 keeps a $250,000 pot for people who are not excluded. Option 6 is a true medical opt-out for a qualifying Medicare household.

If you never make a valid selection, the policy is supposed to issue with unlimited PIP medical.

Recommended reading: Your Guide to Understanding Michigan No-Fault Insurance

WHAT DOES A MEDICARE HOUSEHOLD NEED TO OPT OUT?

To take Option 6 (MCL 500.3107d and DIFS Bulletin 2023-17-INS):

• The applicant or named insured must have Medicare Parts A and B or a Medicare Advantage plan. A Medigap policy sits on top of A and B; it does not replace that requirement.
• Every spouse and resident relative must have qualified health coverage (QHC) or PIP medical on another Michigan auto policy.

QHC means either:

• Medicare Parts A and B (or Advantage), or
• Other health or accident coverage that does not exclude or limit auto-accident injuries, with an annual individual deductible no higher than the DIFS cap

That deductible started at $6,000 in the statute and is indexed. Bulletin 2026-08-INS keeps the cap at $6,579 from July 1, 2026 through June 30, 2027. In-network and out-of-network deductibles both count. DIFS says Medicaid and health-care sharing ministries are not QHC. TRICARE and VA coverage generally are not either (FIS-PUB 8000).

Insurers want proof at issue and at each renewal. If someone in the household loses QHC during the policy term, MCL 500.3107d has rules that can put PIP medical back on the auto policy. Tell the carrier.

CAN I DROP PIP MEDICAL IF I AM NOT ON MEDICARE?

Not with Option 6. That door is for a Medicare qualified person.

What non-Medicare households can do is Option 4: buy $250,000 PIP medical and exclude named people who have QHC that is not Medicare or Medicaid (MCL 500.3109a). Excluded people have no PIP medical on that policy. The $250,000 limit still applies to anyone who was not excluded.

WILL MEDICARE PAY IF I AM HURT IN A CRASH?

Federal Medicare Secondary Payer rules put auto no-fault ahead of Medicare whenever PIP medical is payable (42 U.S.C. § 1395y(b)(2)).

• If you kept PIP medical: PIP pays first, up to the limit you bought. Medicare may pay covered leftover amounts as a secondary payer. DIFS says the same.
• If you opted out, or PIP is exhausted, and there is no other auto medical coverage: Medicare can pay for Medicare-covered services. You still owe deductibles, coinsurance and anything Medicare does not cover. Medicare may make a conditional payment and later take a lien from a liability recovery.

You cannot “coordinate” PIP so that Medicare goes first while PIP is still on the hook. Federal law does not allow that.

WHAT IF I ALSO HAVE EMPLOYER GROUP HEALTH?

That is a different Medicare coordination question (working aged, disability, retiree coverage). CMS still uses the usual size tests: group health is generally primary for people 65+ at employers with 20 or more employees; for people on Medicare because of disability, the usual cutoff is 100 employees; for retiree coverage, Medicare is usually primary.

None of that replaces PIP if PIP is in force. Auto no-fault still sits in front of Medicare for accident care that PIP covers.

DOES MEDICARE COVER THE SAME THINGS AS UNLIMITED PIP?

No. Unlimited PIP medical is supposed to pay allowable expenses that are reasonable and necessary for care, recovery and rehabilitation (MCL 500.3107). Duration follows medical need, not a Medicare cap.

Medicare pays a defined list of Part A and B services, with limits, copays and deductibles. Things PIP often pays that Medicare usually will not (or will cover only in a narrow way) include:

• Round-the-clock or family attendant care
• Mileage to treatment
• Long-term custodial care
• Many home and vehicle modifications
• Some specialized brain-injury therapy

Medicare may cover intermittent skilled nursing, some rehab and speech therapy, and certain durable medical equipment — each with its own rules. Do not assume an electric wheelchair, a nursing-home stay or unlimited PT is automatically in or out. Check the Medicare coverage manual for that item, then compare it to what PIP would have paid.

Recommended reading: What Are the Six PIP Options?

WHAT ABOUT MEDICAID?

Medicaid is a different door: Option 5, $50,000 per person per accident, if the named insured is on Medicaid and the spouse and resident relatives have QHC, Medicaid or another Michigan PIP medical policy (MCL 500.3107c(1)(a)). Medicaid is not QHC for a Medicare opt-out.

CONTACT AN ACCIDENT LAWYER

An insurance agent should help you pick a PIP level. If you or a loved one is already injured — or Medicare is billing you for crash care — we can help with PIP, liens and any claim against an at-fault driver.

Michigan No-Fault law is complicated, but finding the right accident lawyer is simple.

Fill out the brief form below or call 1-800-CALL-SAM today for a free, no-obligation consultation.