PIP vs. Health Insurance vs. Medicare: What Each One Actually Pays After a Michigan Crash

Every Michigan driver who considers dropping from unlimited PIP is really making one bet: that their health plan or Medicare will pick up whatever the auto policy no longer pays. It is a reasonable bet in some cases and a disastrous one in others, and the difference comes down to details almost nobody compares side by side. This is that comparison.

The side-by-side

	Michigan PIP	Typical health plan	Medicare Parts A & B
What it pays for	Reasonable charges for reasonably necessary products, services and accommodations for care, recovery or rehabilitation	Medically necessary services within the plan's benefit categories	Medically necessary hospital and medical services
Does cost sharing reset?	No — one limit per person, per accident	Yes — every plan year	Part B yearly; Part A per benefit period
Out-of-pocket cap	Your selected limit	$10,600 self-only / $21,200 family (2026)	None at all in Original Medicare
In-home attendant care	Yes — long established	Generally excluded	No — expressly excluded
Home modifications	Yes	Not a benefit category	No
Vehicle modifications	Yes — but not the base vehicle	No	No
Dental from the crash	Yes, as accident-related care	No — adult dental is not an essential health benefit	No, with narrow exceptions
Lost wages	Yes — 85%, up to 3 years	No	No
Household tasks you can no longer do	Yes — $20/day, up to 3 years	No	No

1. The annual reset is the difference people underestimate

This is the point that changes how the whole decision looks, and it is the one most people miss when they compare a PIP limit against "I have good health insurance."

A health plan's deductible and out-of-pocket maximum are annual accumulators. HealthCare.gov defines the out-of-pocket maximum as the most you pay "in a plan year," and Michigan carrier certificates say the same thing — Blue Care Network's 2026 certificate defines it as the most you pay "during a Calendar Year." On January 1, everything zeroes out and you start paying again.

For an ordinary year of medical care, that is fine. For a catastrophic auto injury, it is a recurring bill for the rest of your life. Consider the 2026 numbers:

• The ACA out-of-pocket maximum for 2026 is $10,600 for self-only coverage and $21,200 for family coverage. A person with lifelong injury-related care can reasonably expect to hit that ceiling every year.
• Those limits are climbing fast. The 2025 figures were $9,200 and $18,400 — a 15 percent jump in a single year. CMS has already published $12,000 and $24,000 for 2027.
• The average employer deductible for single coverage was $1,886 in 2025, and $2,631 at small firms, per KFF's Employer Health Benefits Survey. A 2026 high-deductible plan can require $1,700 for an individual or $3,400 for a family before it pays anything.

Michigan PIP works on a fundamentally different clock. MCL 500.3107c states each limit "per individual per loss occurrence." One accident, one bucket, and it never refills — but it also never resets against you. And note the structure of MCL 500.3107(1): work loss and replacement services are expressly limited to "the first 3 years after the date of the accident," while allowable expenses carry no time limit at all. With unlimited PIP, medical care arising from that crash is claimable for life.

So the honest framing is not "health insurance runs out." Under the ACA, plans cannot impose annual or lifetime dollar limits on essential health benefits (45 CFR 147.126) — that is a genuine protection and PIP has no equivalent structural advantage there. The framing is: health insurance makes you pay again every year, and it excludes entire categories of what a crash victim needs.

The limits health plans can still impose

The dollar-limit ban is narrower than it sounds. It applies only to essential health benefits, and it bans dollar caps — not visit or day caps. Michigan's own federally approved essential-health-benefits benchmark plan, published by CMS, contains hard quantitative limits:

• Outpatient rehabilitation: 30 visits per year, applying to all rehabilitation services combined.
• Home health care: 45 days per year.
• Skilled nursing facility: 45 days per year.
• Chiropractic care: 30 visits per year.

Thirty rehab visits is roughly ten weeks of three-times-weekly therapy. For someone relearning to walk, that is a fraction of the first year.

2. What health insurance flatly will not cover

These are the categories that consume a catastrophic claim, and they are the ones health plans are not built for.

• Custodial and personal care. Blue Care Network's 2026 Michigan certificate states it plainly: custodial care "is care primarily used to help the Member with activities of daily living or meet personal needs... Custodial Care is not covered." It also excludes private duty nursing from its definition of skilled care.
• Long-term care is not one of the ten essential health benefits. There is no EHB category for long-term services, attendant care, home modification or vehicle modification. What is not a benefit category cannot be a covered benefit.
• Home and vehicle modifications. Medicare's own durable medical equipment reference list denies stairway elevators, grab bars, raised toilet seats and bathtub lifts as "not primarily medical in nature." In Michigan, when these are funded at all through a public program, it is through Medicaid home-and-community-based waivers such as MI Choice — which cover "environmental accessibility adaptations" and "vehicle modifications" precisely because ordinary health coverage does not.
• Out-of-network care. Amounts you pay out of network generally do not count toward your out-of-pocket maximum, and balance billing remains possible. Worth knowing after a crash: the federal No Surprises Act protects you for emergency services and air ambulance, but expressly does not cover ground ambulance — often the very first bill you receive.

Michigan PIP covers this territory, and has for decades. Attendant care — including in-home care provided by family members, compensated at market rates — is long established in Michigan case law. Home modifications are too: in one case a Michigan court held an $88,000 home addition built for accessibility to be an allowable expense, along with apartment rent while the work was underway. Vehicle modifications are payable, though the Michigan Supreme Court held in Admire v. Auto-Owners (2013) that the base price of a van is an ordinary transportation expense the insurer need not fund. Mileage to and from medical treatment is payable as well.

3. Dental: a real gap on both sides

Facial and dental trauma is common in serious crashes, and it lands in a coverage no-man's-land.

• Your health plan is not a dental plan. Adult dental coverage is not an essential health benefit, which means a plan can exclude it outright or cap it in dollars. Dental care appears on the standard federal Summary of Benefits and Coverage template's list of services plans do not cover.
• Standalone dental plans cap out low — and have for decades. The American Dental Association noted in December 2025 that many plans still promote the $1,000 annual maximum "established some 40 years ago," and that many dental plans' annual maximums "have not increased in 50 years." Per National Association of Dental Plans data the ADA cites, about 33 percent of plans cap between $1,000 and $1,500 and another 48 percent between $1,500 and $2,500.
• And they pay a fraction of major work. The 2026 federal FEDVIP dental plan pays 50 percent of the allowance in network for major restorative services — crowns, bridges, dentures — and 60 percent out of network plus anything above the allowance. Twelve-month waiting periods for major services are common.
• Medicare is worse. Original Medicare does not cover routine cleanings, fillings, extractions, dentures or implants. The exceptions are narrow and tied to other medical care — dental work before a heart valve replacement or organ transplant, clearing a mouth infection before cancer treatment, oral exams tied to dialysis.

Now do the arithmetic. A crash that costs you several teeth can easily run into five figures of implants and reconstruction. A $1,500 dental maximum covers a fraction of one implant. Michigan PIP treats dental treatment arising from the accident as an allowable expense under the general standard in MCL 500.3107(1)(a) — care and recovery from the injury — with no dental annual maximum sitting on top of it.

4. Medicare specifically — and why Option 6 deserves a hard look

If you carry Medicare Parts A and B, Michigan lets you opt out of PIP medical entirely. Before you do, understand exactly what you are relying on.

The Part A deductible is not annual

This surprises almost everyone. The 2026 Part A inpatient hospital deductible is $1,736 per benefit period — not per year. A benefit period begins when you are admitted and ends only after you have been out of the hospital or skilled nursing facility for 60 consecutive days. The Medicare & You 2026 handbook says it directly: "You must pay the Part A deductible each time you start a new benefit period. This could be multiple times in a calendar year."

A crash victim discharged and readmitted two months later pays $1,736 again.

Original Medicare has no out-of-pocket maximum

This is the single most important fact in this section, and it is verbatim from Medicare's own materials: "There's no yearly limit on what you pay out of pocket if you have Original Medicare." Part B covers most services at 80 percent, leaving you responsible for 20 percent — of an unlimited number. Twenty percent of a catastrophic injury is itself catastrophic.

Medigap or a Medicare Advantage plan changes this. Medicare Advantage plans carry a CMS-set maximum out-of-pocket, capped at $9,250 in network for 2026. Original Medicare alone does not.

The other 2026 Medicare numbers

• Part B: $283 annual deductible, $202.90 standard monthly premium, then 20 percent coinsurance.
• Hospital days 61–90: $434 per day. Lifetime reserve days: $868 per day, and you get only 60 of them, once, ever. After day 150, you pay everything.
• Skilled nursing: $0 for days 1–20, then $217 per day for days 21–100 — that alone is $17,360 out of pocket across a single benefit period — and Medicare covers no SNF days beyond 100 per benefit period. It also requires a qualifying inpatient hospital stay of at least three days first.

Medicare will not pay for the care that matters most

Medicare's home health benefit requires you to be homebound, to need skilled care, and to be certified by a provider — and it is explicitly part-time or intermittent. Medicare.gov states in plain terms that it does not pay for:

• "24-hour-a-day care at your home"
• "Homemaker services" such as shopping and cleaning, unrelated to your care plan
• "Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need"

Medicare.gov is equally direct on long-term care: "Medicare doesn't pay for long-term care," and neither do most health plans or Medigap policies. That is exactly the care a serious auto injury generates.

You cannot coordinate PIP with Medicare

One structural point that gets missed: DIFS states that Michigan PIP cannot be coordinated with Medicaid, Medicare, Medicare Supplement or Medicare Advantage. Coordination — where your health plan pays first at a reduced auto premium — is only available with private health and disability coverage. With Medicare, PIP is the primary payer up to your selected limit, and Medicare picks up as secondary after that.

We cover the opt-out decision in detail in Michigan No-Fault Option 6.

5. What PIP pays that neither of the others touch

Health insurance and Medicare are medical payers. Michigan PIP is broader by statute — MCL 500.3107(1) creates three categories, and two of them have no health-insurance equivalent whatsoever:

• Work loss. 85 percent of the income you would have earned, for up to three years after the accident. The 15 percent reduction exists because the benefit is not taxable — the statute says so explicitly. The maximum is $7,455 per 30-day period for accidents occurring between October 1, 2026 and September 30, 2027 (up from $7,201 the prior year), per DIFS Bulletin 2026-20-INS. Important: the maximum is fixed by your accident date and does not rise with later bulletins.
• Replacement services. Up to $20 per day for ordinary and necessary services you would have performed yourself — lawn care, snow removal, childcare, housekeeping — for up to three years. That figure dates to 1973 and has never been indexed, so treat it as real but small.
• Funeral and burial expenses, set by the policy within a statutory band of $1,750 to $5,000.
• Survivor's loss benefits for dependents, subject to the same $7,455 monthly maximum and a three-year limit.

Your health plan pays none of this. Neither does Medicare.

What this actually costs, in numbers

The reason any of this matters is scale. The National Spinal Cord Injury Statistical Center's 2025 figures, in 2024 dollars, put lifetime costs for a spinal cord injury sustained at age 25 at roughly $3.06 million for paraplegia and $6.26 million for high tetraplegia — and those figures cover health care and living expenses only, excluding lost wages and productivity, which NSCISC estimates at another $95,309 per year on average.

On the attendant care side, CareScout's 2025 Cost of Care Survey puts non-medical in-home care at a national median of $35 an hour. The commonly quoted "$80,080 a year" figure assumes only 44 hours a week — about a quarter of the week. By our arithmetic at that same hourly median, genuine round-the-clock care runs about $306,600 a year. Michigan-specific figures from the 2024 survey year put a home health aide at $77,792 annually and homemaker services at $75,504, again at 44 hours a week.

Set that against a $250,000 PIP limit and the math is uncomfortable. Set it against a $50,000 limit and it is over before the first year ends.

Two things that make PIP less generous than it looks

Being straight about the other side of the ledger:

• Family-provided attendant care is capped at 56 hours a week. Under MCL 500.3157(10), care rendered in the injured person's home by a relative, a household member, or someone with a pre-injury business or social relationship is subject to the Worker's Disability Compensation Act's hourly limit — 56 hours per week. An insurer may agree to pay more (MCL 500.3157(11)), but is not required to. Note this cap and the medical fee schedule apply only to injuries on or after June 11, 2019 — the Michigan Supreme Court held in Andary v. USAA (2023) that people injured before the reform keep their prior benefits.
• Provider payment is capped by a fee schedule. Under MCL 500.3157, amounts payable are tied to percentages of Medicare rates, adjusted annually. Per DIFS Bulletin 2026-09-INS, the cumulative increase over January 1, 2019 amounts is 16.38 percent, effective July 2, 2026 through July 1, 2027. This has made some providers harder to access.
• You have to keep claiming. Michigan's one-year-back rule (MCL 500.3145) means you cannot recover benefits for any portion of a loss incurred more than one year before you file suit. Benefits can last a lifetime, but sitting on unpaid bills forfeits them.

The coordination decision

Michigan lets an insurer offer coordinated PIP at a reduced premium (MCL 500.3109a(1)), meaning your health plan pays first. It can be a sensible saving — but DIFS attaches a warning worth repeating: before you agree to coordinate, "you must first verify that your health and/or disability income insurance policy will provide benefits for injuries related to a car accident."

Three risks to weigh:

• A high-deductible health plan. Coordinated, you eat that deductible and coinsurance first — potentially $3,400 for a family before anything pays.
• Losing the plan. If you took the qualified-health-coverage exclusion at the $250,000 level and that coverage ends, you have 30 days to obtain PIP coverage. Miss it and get hurt, and MCL 500.3109a(2)(e) says you are not entitled to PIP benefits for that injury at all.
• PIP deductibles have no statutory ceiling. The old $300 cap was repealed in 2012, and PIP medical deductibles as high as $10,000 are now being sold in Michigan. Read your declarations page.

The bottom line

Health insurance and Medicare are good at what they are built for: doctors, hospitals, prescriptions, ongoing treatment. Neither was designed to rebuild a life around a permanent injury. They reset your costs every year, they cap therapy in visits rather than dollars, they exclude custodial and attendant care outright, and they will not pay to widen a doorway or adapt a van.

That does not mean everyone needs unlimited PIP. It means the decision should be made by comparing your specific health plan's deductible, out-of-pocket maximum and exclusions against the specific PIP level you are considering — not by assuming health insurance will simply cover it.

We are an independent agency in Lake Orion, and this is a conversation we have with clients constantly. Bring us your health plan's summary of benefits and your current declarations page, and we will walk through what each PIP level would actually cost you and actually leave exposed. Compare Michigan auto insurance across our carriers by requesting a free quote, or call (248) 693-6455 and ask for a PIP review. Start with our guide to Michigan PIP medical coverage levels to see what each tier costs.

Frequently Asked Questions

Does health insurance cover car accident injuries in Michigan?

Usually yes for medical treatment, but not for everything PIP covers. Health plans pay for doctors, hospitals and prescriptions, subject to your annual deductible and out-of-pocket maximum. They generally do not cover in-home attendant care, custodial care, home modifications, vehicle modifications, lost wages or replacement services — all of which Michigan PIP does cover. Some health plans also exclude auto-accident injuries entirely, which is why DIFS advises verifying this before coordinating coverage.

Do health insurance deductibles reset every year?

Yes. Deductibles and out-of-pocket maximums are annual accumulators that reset at the start of each plan year. For 2026 the ACA out-of-pocket maximum is $10,600 for self-only and $21,200 for family coverage, up from $9,200 and $18,400 in 2025. Someone with lifelong injury-related care can expect to reach that ceiling every year. A Michigan PIP limit works differently — it is stated per person per loss occurrence and does not reset.

Does Medicare cover in-home attendant care after a car accident?

No. Medicare's home health benefit requires you to be homebound and to need part-time or intermittent skilled care. Medicare.gov states specifically that it does not pay for 24-hour-a-day care at home, homemaker services, or custodial and personal care with daily living activities when that is the only care you need. Medicare also does not pay for long-term care, and Medigap policies do not fill that gap.

Does Medicare have an out-of-pocket maximum?

Original Medicare does not. Medicare.gov states there is no yearly limit on what you pay out of pocket with Original Medicare, and Part B leaves you responsible for 20 percent of most services with no cap. Medicare Advantage plans do carry a maximum out-of-pocket, capped by CMS at $9,250 in network for 2026. Note also that the 2026 Part A hospital deductible of $1,736 is charged per benefit period, not per year, so it can be owed more than once in a calendar year.

Does insurance cover dental work after a Michigan car accident?

Michigan PIP treats dental treatment arising from the accident as an allowable expense for care and recovery, with no separate dental maximum. Your health plan generally will not, because adult dental is not an essential health benefit. A standalone dental plan will pay, but most cap at $1,000 to $2,500 a year — a level the American Dental Association notes has barely moved in decades — and typically pay only about 50 percent of major restorative work.

What does Michigan PIP pay that health insurance doesn't?

Beyond medical care, MCL 500.3107 provides work loss at 85 percent of lost income for up to three years (maximum $7,455 per 30-day period for accidents between October 1, 2026 and September 30, 2027), replacement services up to $20 per day for three years, funeral and burial expenses of $1,750 to $5,000 set by the policy, and survivor's loss benefits for dependents. Health insurance and Medicare pay none of these.

Can I coordinate my Michigan PIP with Medicare?

No. DIFS states that PIP cannot be coordinated with Medicaid, Medicare, Medicare Supplement or Medicare Advantage. Coordination at a reduced premium is available only with private health and disability coverage. With Medicare, your PIP coverage is the primary payer up to your selected limit and Medicare pays as secondary after that.