One of the major changes that no-fault reform is bringing to the auto insurance landscape is the option to select different medical benefit levels. Drivers will have choices moving forward in their Personal Injury Protection (PIP) coverage, that if selected, could have significant consequences in the event of an accident.
As of July 1st, 2020, seniors will have the option to completely opt-out from no-fault allowable expense PIP benefits if:
- They have coverage under Parts A and B of Medicare, AND
- The person’s spouse and any resident relative has Medicare qualified health coverage or has no-fault PIP coverage under a separate policy.
Those who select to opt-out are not entitled to coverage through the Assigned Claims Plan when injured as an occupant of a motor vehicle, but are likely entitled to Assigned Claims Plan coverage up to $250,000 when injured as a non-occupant of a motor vehicle and there is no other insurer in the line of priority from which to recover PIP benefits.
Coverage | Auto No-Fault | Medicare |
Alternative Pain Management (such as acupuncture) | Covered | Not covered |
Attendant Care (assistance with care/supervision ) | Covered 24/7 as long as needed | Limited to home health aide services 2-3 times weekly for four hours during acute recovery only |
Case Management Service | Covered | Not covered |
Durable Medical Equipment (walkers/wheelchairs/etc.) | Covered | Covered at 80% |
Guardianship or Conservators | Covered | Not covered |
Home Modifications to Ensure Accessibility | Covered | Limited coverage |
Long-Term Care/Custodial Care | Covered 24/7 if needed | Not covered |
Massage Therapy | Covered | Not covered |
Occupational Therapy | Covered | Limited coverage at 80% and capped at $2,040/year |
Physical, Speech and other Outpatient Therapies | Covered | Limited coverage at 80% and capped at $2,040/year |
Post-Acute Care/Subacute Rehabilitation | Covered 100% as long as needed | Limited coverage of 100 days at 80% |
Replacement Services (homemaker services, personal care, meal assistance, etc.) | Covered up to three years at $20/day | Not covered |
Residential Treatment Programs | Covered | Not covered |
Specialty Assistive Devices (computers, assistive electronics, communication devices, fitness equipment) | Covered | Limited coverage |
Transportation Services (to and from medical appointments) | Covered | Not covered |
Vehicle Modifications (accommodate wheel chairs, hand controls, etc.) | Covered | Not covered |
Wage Loss (if senior is still working) | Covered | Not covered |
