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The Rathbun Agency Blog

All You Ever Wanted to Know About Insurance

Auto No-Fault vs. Medicare - What's Covered?

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