Which PIP medical limit applies to you, and what does the fee schedule do to your bills?
I am Mitchell Bisson, a Grand Rapids personal injury lawyer. I have litigated for over 15 years. This page explains the two parts of Michigan’s 2019 no-fault reform that most often decide how much medical care an insurer will pay: the personal protection insurance (PIP) medical coverage level on the policy, and the medical fee schedule in MCL 500.3157. The first sets the ceiling on what the policy pays for your care. The second caps what each provider can be paid for it. I start these cases with the policy, the selection form and the bills. I do not promise outcomes.
The short answer. For a policy issued or renewed after July 1, 2020, the named insured selects a PIP medical limit per person per accident: $50,000 (only for a person enrolled in Medicaid whose household also has other coverage), $250,000, $500,000 or no limit. MCL 500.3107c(1). The selection has to be made on an approved form in a way the statute allows, and if there was no effective selection and no premium presumption applies, the policy is treated as unlimited. MCL 500.3107c(3), (4). Separately, MCL 500.3157 limits what a provider can be paid for treatment after July 1, 2021 to a percentage of Medicare, and 190% is the general figure for treatment after July 1, 2023. Nothing here predicts how your claim will end.
Before the 2019 amendments, PIP medical benefits for allowable expenses were unlimited, as the Court of Appeals noted in Mary Free Bed Rehabilitation Hospital v Esurance Prop & Cas Ins Co, No. 370846 (Mich Ct App Mar 2, 2026). That is why most older no-fault disputes were about which insurer paid. Now there are two more questions: how much the policy pays, and how much the provider may be paid. Two people hurt in the same crash can have different limits, because the limit comes from the policy that applies to each of them and not from the crash.
The reform came from 2019 PA 21 and 2019 PA 22, effective June 11, 2019. The coverage level rules apply to policies issued or renewed after July 1, 2020. MCL 500.3107c(1). I checked the statutes on this page against the Legislature’s published text, which was complete through 2026 PA 114, and I found no amendment to MCL 500.3107c or MCL 500.3157 after the 2019 acts. What has kept changing is the case law, and I have put the 2025 and 2026 decisions that matter into the sections below.
The coverage levels and who can choose each
The statute gives four limits for allowable expenses, plus two ways to carry no PIP medical coverage at all. The table sets out each choice and who is allowed to make it.
| Choice | Who can make it | What it means for PIP medical benefits | Authority |
|---|---|---|---|
| $50,000 limit | Only an applicant or named insured who is enrolled in Medicaid, when the spouse and any relative of either who lives in the household have qualified health coverage, are enrolled in Medicaid, or have PIP medical coverage from an insurer providing the required security | A limit of $50,000 per individual per loss occurrence on allowable expenses | MCL 500.3107c(1)(a) |
| $250,000 limit | An applicant or named insured | A limit of $250,000 per individual per loss occurrence | MCL 500.3107c(1)(b) |
| $500,000 limit | An applicant or named insured | A limit of $500,000 per individual per loss occurrence | MCL 500.3107c(1)(c) |
| No limit | An applicant or named insured. It is also the level that applies when there was no effective selection and no premium presumption | No limit on allowable expenses | MCL 500.3107c(1)(d), (4) |
| Election to not carry PIP medical coverage | A named insured who has Medicare Parts A and B, when the spouse and resident relatives have qualified health coverage or PIP medical coverage from an insurer | The policy does not provide PIP medical coverage to the named insured, the spouse, resident relatives or anyone else who would have claimed under the policy | MCL 500.3107d(1), (5) |
| Qualified health coverage exclusion | Offered by the insurer to an applicant who selects the $250,000 limit | A person subject to the exclusion is not eligible for PIP benefits under the policy, and the premium is reduced | MCL 500.3109a(2) |
What the limit covers and what it does not
The limit applies to benefits under MCL 500.3107(1)(a), which are allowable expenses: reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery or rehabilitation. It is a limit per individual per loss occurrence, so each injured family member has a separate limit for the same crash. Work loss and replacement services are paid under MCL 500.3107(1)(b) and (c), and the limit in MCL 500.3107c is written as a limit on benefits under section 3107(1)(a).
Who the limit follows. The level selected by the named insured applies to the named insured, the spouse, a relative of either who is domiciled in the same household, and any other person with a right to claim PIP benefits under the policy. MCL 500.3107c(5). Domicile is decided on the facts. In Frownfelter v Esurance Prop & Cas Ins Co, Nos. 168356 and 168357 (Mich July 22, 2026), the Michigan Supreme Court held that a custody order does not determine a child’s domicile for no-fault purposes and overruled the contrary rule from Grange Ins Co of Mich v Lawrence, 494 Mich 475 (2013). The Court said a custody order is a starting point, that courts should look to the traditional domicile factors, and that when parents share joint custody they should also consider where the child actually spends the majority of the time and sleeps most nights. If your child splits time between two homes, that decides whose policy and whose limit apply.
Two policies do not add up. If benefits are payable under two or more policies, they are payable only up to an aggregate limit equal to the highest available limit under any one of them. MCL 500.3107c(6). A $250,000 policy and a $500,000 policy do not combine to $750,000. Separately, when the limit on the policy of the insurer first in line is used up, a claimant may be able to move down the priority list. In Mary Free Bed Rehabilitation Hospital v Esurance Prop & Cas Ins Co, No. 370846 (Mich Ct App Mar 2, 2026), a published decision, the Court of Appeals held that an injured motorcyclist or the treating provider could claim from a lower-priority insurer with unlimited coverage once the $250,000 limit of the higher-priority insurer was exhausted. MCL 500.3114(5). That holding came from the motorcycle priority rules, and I do not assume it reaches every kind of claim.
After the limit is used up. The tort statute preserves a claim against the person at fault for allowable expenses, work loss and survivor’s loss “in excess of any applicable limit under section 3107c,” and “without limit” for allowable expenses if an election to not maintain coverage was made under section 3107d or an exclusion under section 3109a(2) applies. MCL 500.3135(3)(c). That is a claim against the driver or owner who caused the crash, so fault is part of it. It is separate from the claim for noneconomic damages, which has its own threshold.
How a coverage level is chosen, and what makes the choice effective
The coverage selection is not a casual checkbox. The statute requires an approved form that states, in a conspicuous manner, the benefits and risks of each option, gives the applicant a way to mark that he or she has read the form and understands the options, lets the applicant mark the selection, and requires a signature. MCL 500.3107c(2).
The form has to be delivered by personal delivery, first-class mail or electronic means in accordance with section 2266 of the insurance code. MCL 500.3107e(1). The selection itself has to be made in one of three ways: marking and signing a paper form; giving verbal instructions, in person or by telephone, that the form be marked and signed on the person’s behalf; or electronically marking the form and providing an electronic signature under the uniform electronic transactions act. MCL 500.3107e(2). For verbal instructions, the instructions must be recorded and the recording kept by the person who received them, and if there is a dispute, there is a presumption that the selection was not effective and the insurer has the burden of rebutting it with the recording. MCL 500.3107e(2)(b).
If the selection was not effective, two rules decide what happens. When a premium or installment has been paid, there is a rebuttable presumption that the amount paid accurately reflects the level of coverage on the policy. If there was no effective selection and that presumption does not apply, the policy is treated as having no limit. MCL 500.3107c(3), (4).
Mary Free Bed Rehabilitation Hospital v Esurance Prop & Cas Ins Co, No. 370846 (Mich Ct App Mar 2, 2026) shows how the two rules work together. The insurer’s only evidence of the selection was a form showing the insured’s typed name and a date. The insured testified that she remembered choosing coverage online but did not remember seeing the form or signing it. The court held that the insurer had not shown an effective selection. It then held that the insurer was still entitled to the premium presumption, because the insured had paid premiums and the declarations page showed a premium allocated to PIP coverage and a $250,000 limit for PIP medical, so the $250,000 limit applied. The court also said the presumption is not self-executing, and that the insurer must connect the premium paid to the level of coverage. So a missing signature does not by itself make a policy unlimited, and a signed-looking form does not by itself make it limited. It is a Court of Appeals decision, and I check its status before I rely on it in a particular case.
Opting out of PIP medical coverage and the health coverage exclusion
Health insurance by itself does not let anyone skip PIP medical coverage. The statute gives two routes, and each has conditions.
The Medicare election. A named insured who has Medicare Parts A and B can elect, on the approved form, to not maintain PIP medical coverage, but only if the spouse and any relative of either who lives in the household have qualified health coverage or PIP medical coverage from an insurer. MCL 500.3107d(1). Qualified health coverage means other health or accident coverage that does not exclude or limit coverage for injuries related to motor vehicle accidents and has an annual deductible of $6,000 or less per individual, adjusted each year, or Medicare Parts A and B. MCL 500.3107d(7)(b). The election applies to the named insured, the spouse, relatives domiciled in the household and anyone else who would have had a right to claim under the policy. MCL 500.3107d(5). If there was no effective election, the policy is treated as providing the no-limit level. MCL 500.3107d(4).
The qualified health coverage exclusion. For a policy issued or renewed after July 1, 2020, the insurer must offer an exclusion related to qualified health coverage to an applicant who selects the $250,000 limit. If the named insured and the household members all have qualified health coverage that covers motor vehicle injuries, the premium for PIP medical benefits must be reduced by 100%, and a person subject to the exclusion is not eligible for PIP benefits under the policy. MCL 500.3109a(2)(a), (c). The exclusion reaches only the named insured, the spouse and relatives domiciled in the household. MCL 500.3109a(1). In Love v Rudolph, No. 369895 (Mich Ct App Dec 18, 2025), the Court of Appeals applied that limit and held that a motorcyclist outside the policyholder’s household was not a person who could be excluded.
When the health coverage ends. Under either route, if the qualifying coverage ends, the named insured has 30 days to buy a policy that includes PIP medical coverage. MCL 500.3109a(2)(d)(i); MCL 500.3107d(6)(a). Under the exclusion route, an excluded person who is hurt in a motor vehicle accident during that 30-day window is entitled to claim through the assigned claims plan. MCL 500.3109a(2)(d)(ii). Under the Medicare route, a person covered by the election who is hurt in the window after the named insured fails to obtain the coverage, and who is not entitled to coverage under some other policy, is not entitled to PIP medical benefits under that policy but may claim through the assigned claims plan. MCL 500.3107d(6)(c). The assigned claims plan’s medical obligation for those claimants is $2,000,000 instead of the usual $250,000. MCL 500.3172(7). If the named insured does not obtain the coverage in time, an injured person with no other policy is not entitled to PIP medical benefits for an injury that occurred while the exclusion applied. MCL 500.3109a(2)(e). A lapse in health insurance can therefore change who pays for the same injury, so I ask for the date the health coverage ended and the date the crash happened.
The medical fee schedule in MCL 500.3157
The fee schedule applies to treatment, training and rehabilitative occupational training rendered after July 1, 2021. MCL 500.3157(14). Under the general rule, a provider may charge a reasonable amount that does not exceed what it customarily charges for like treatment in cases that do not involve insurance. MCL 500.3157(1). The statute caps what a provider is eligible to be paid at a percentage of the amount payable under Medicare. The general percentage was 200% for treatment after July 1, 2021 and before July 2, 2022, 195% for the next year, and 190% for treatment after July 1, 2023. MCL 500.3157(2). The table shows the figures for treatment after July 1, 2023.
| Who is paid | Cap for treatment after July 1, 2023 | If Medicare has no amount payable | Authority |
|---|---|---|---|
| Physicians, hospitals, clinics and other providers generally | 190% of the amount payable under Medicare | 52.5% of the amount payable under the provider’s charge description master in effect on January 1, 2019, or of its average January 1, 2019 charge if it had no such master | MCL 500.3157(2)(c), (7)(a) |
| Providers with 20% or more but under 30% indigent volume, and up to two freestanding rehabilitation facilities designated by the director each year | 220% | 66.5% | MCL 500.3157(3), (4), (7)(b) |
| Providers that meet the 30% threshold in subsection (5) | 250% | 78% | MCL 500.3157(5), (7)(c) |
| Level I and level II trauma centers, for emergency treatment before the patient is stabilized and transferred | 230% | 71% | MCL 500.3157(6), (7)(d) |
| Emergency medical services by an ambulance operation | Not subject to subsections (2) to (12) | Not applicable | MCL 500.3157(13) |
Three other parts of the statute matter in practice. First, an amount allowed under the Medicare-based caps must not exceed the average amount the provider charged for the treatment on January 1, 2019. MCL 500.3157(8). Second, the January 1, 2019 amounts are adjusted each year by the medical care component of the Consumer Price Index. MCL 500.3157(9). Third, the statute defines Medicare as fee-for-service payments under parts A, B or D “without regard to the limitations unrelated to the rates in the fee schedule such as limitation or supplemental payments related to utilization, readmissions, recaptures, bad debt adjustments, or sequestration.” MCL 500.3157(15)(f). A neurological rehabilitation clinic must also be accredited to be paid, with a limited exception for clinics in the process of accreditation on July 1, 2021. MCL 500.3157(12).
Fee schedule disputes that come up in real claims
Medicare payment rules. Insurers often reduce a provider’s bill using adjustments that Medicare applies. In Favot v Brown, No. 368733 (Mich Ct App Sept 18, 2025), a published decision, the Court of Appeals held that an insurer may apply Medicare limitations that are related to the rates in the fee schedule, and gave three examples: the multiple procedure payment reduction, the packaged-service rule and geographic billing modifiers. It held that limitations of the kind the statute lists as unrelated, such as readmissions, bad debt and sequestration, may not be used. The court sent the case back because factual questions remained about the amounts, so the ruling gives a framework and not a number.
Services Medicare does not pay for. The fallback percentages in section 3157(7) apply only when Medicare does not provide an amount payable. In West Michigan Home Care Services, Inc v Meemic Ins Co, No. 369151 (Mich Ct App Oct 20, 2025), a published decision from a Kent County case, the insurer paid about $19 an hour for home-health-aide care after July 2021 where it had paid $31 before. The Court of Appeals held that because Medicare has billing codes for home-health-aide and skilled-nursing care, there were amounts payable under Medicare, so the cap in section 3157(2) applied and not the lower fallback in subsection (7). The court added that whether the section 3157(8) average-charge cap applies remained open for the trial court.
Injuries before June 11, 2019. In Andary v USAA Cas Ins Co, 512 Mich 207 (2023), the Michigan Supreme Court held that the scope of PIP benefits vests at the time of injury and that the amended MCL 500.3157(7) and (10) do not apply to an insured who was injured while covered by a policy issued before June 11, 2019. In Fremont Ins Co v Lighthouse Outpatient Ctr, No. 370500 (Mich Ct App Apr 11, 2025), a published decision, the Court of Appeals held that the reasoning of Andary is not limited to subsections (7) and (10) and reaches the other amended fee provisions at issue there, for a patient injured in a 2018 crash who was insured under a Fremont policy. The services in dispute were provided in 2023, and the court held that the pre-amendment reasonable and customary standard governed them instead of the post-amendment fee schedule. It rejected the contrary reading in a Department of Insurance and Financial Services bulletin. One judge concurred in part and declined to join the analysis of services rendered after the amendments took effect, and because this is a Court of Appeals decision I check for further review before I rely on it. The policy issue date, the injury date and the date of service all matter, and I confirm each one before I say which version of the statute governs.
How I handle a coverage level or fee schedule problem
- Get the policy. I obtain the policy and the declarations pages that were in force on the accident date, together with every renewal.
- Test the selection. I request the selection form and the proof of delivery and signature, and I compare them with sections 3107c and 3107e.
- Map the people and the policies. I list every person with a claim, every policy that might apply, and the limit for each, including household members and anyone with a separate policy.
- Sort the bills. I group the bills by provider tier and date of service, and I flag attendant care, ambulance charges and any services Medicare does not cover.
- Check the payment math. I compare what was paid with what the schedule allows and with the provider’s January 1, 2019 charges, and I ask the insurer for its calculation.
- Put the dispute in writing. I send a written demand that identifies the limit, the amounts and the basis, and I track the overdue dates for interest.
- File when needed. If the insurer will not correct a payment or a limit, I file suit well before the one-year deadlines run, and I plan for the next step if the limit is real.
Ways a coverage level or fee dispute may end
A coverage level dispute can end with the insurer agreeing that the policy is unlimited, with a ruling on whether the selection was effective, or with the limit confirmed and the case turning to the at-fault driver for the excess. A fee dispute can end with an agreed recalculation of the bills, a ruling on which section of the statute applies, or a payment of the overdue amount with interest. Many of these claims settle. Some are decided on motion, and some go to trial. I explain the options as the facts develop, and you decide. I do not promise outcomes.
What I need from you
Bring the declarations pages for the policy that covered you and for every policy in your household, along with renewal notices, any coverage selection form and any letter from the insurer about your limit. Bring the explanations of benefits and the bills from every provider, your claim number, and a list of who treated you and when. Tell me who lives in your home and where each person sleeps, whether anyone has Medicare, Medicaid or other health coverage, and the dates any health coverage began or ended. If the injury happened before June 11, 2019, bring the policy that was in force then. If family members provide your care at home, bring a log of who provides it, where and how many hours.
Where your Kent County injury case will be heard
I represent clients in Grand Rapids, Kentwood, Grandville, Wyoming and across Kent County. Under MCL 600.8301(1), the district court has exclusive jurisdiction in civil actions when the amount in controversy does not exceed $25,000. Michigan law sets the Kent County district courts by municipality. The 61st District Court serves the city of Grand Rapids, the 59th serves the cities of Grandville and Walker, the 62A serves the city of Wyoming and the 62B serves the city of Kentwood. MCL 600.8128a; MCL 600.8130(1)-(3). The 63rd District Court serves the rest of Kent County, which includes the cities of Rockford, Lowell, Cedar Springs and East Grand Rapids and the surrounding townships. MCL 600.8130(4). A claim above the district court’s $25,000 limit is filed in the Kent County Circuit Court, which is the 17th Judicial Circuit. MCL 600.518; MCL 600.601(1).
Why people hire me for a coverage level or fee schedule matter
You work directly with me, the lawyer handling your case. I read the policy and the selection form myself, I explain what each limit and each cap means for your care, and I tell you where a position is strong and where it is thin. I do not promise outcomes. I work from the documents, the statute and the decisions, and we decide together how to proceed.
My fee depends on the type of case, how complicated it is and whether it is likely to go to trial. We talk about the fee at the consultation, before you decide whether to hire me.
Questions I hear about PIP medical limits and the fee schedule
What are the Michigan PIP medical coverage levels and which one do I have?
For policies issued or renewed after July 1, 2020, Michigan lets the named insured choose PIP medical limits of $250,000, $500,000 or unlimited, with a $50,000 option available only in limited cases tied to Medicaid. The limit applies per person per accident. Your declarations page or the coverage selection form you signed shows which level you chose.
Who is allowed to choose the $50,000 PIP medical limit in Michigan?
The $50,000 PIP medical limit is available only if the applicant or named insured is enrolled in Medicaid and the spouse and any relative living in the household also have qualified health coverage, are enrolled in Medicaid, or have PIP medical coverage from a Michigan auto insurer. It is not an option for everyone who wants a lower premium.
Can I opt out of PIP medical coverage because I have health insurance, and what if I lose that insurance?
Sometimes, but health insurance alone is not enough. There are two routes. A person enrolled in Medicare Parts A and B, which MCL 500.3107d calls a qualified person, can elect on the approved form to not carry PIP medical coverage, but only if the spouse and resident relatives have qualified health coverage or PIP medical coverage from an insurer. Separately, an insurer must offer an exclusion tied to qualified health coverage to an applicant who selects the $250,000 PIP medical limit under MCL 500.3109a(2), and a person subject to it is not eligible for PIP benefits under that policy. If the qualifying health coverage ends, the named insured has 30 days to obtain PIP medical coverage, and a covered person hurt in that window who has no other policy may claim through the assigned claims plan.
What PIP medical limit applies if I never made a selection or signed the form?
If a policy was issued or renewed after July 1, 2020 and no effective selection was made, the policy is treated as having unlimited PIP medical coverage unless a rebuttable presumption applies that the premium paid reflects the coverage level. The insurer has to use the approved form, so a missing or defective form can matter.
Does the PIP limit chosen by the policyholder apply to my spouse and children, and what if two policies apply?
Yes. The coverage level selected by the named insured applies to the named insured, the spouse, relatives of either who are domiciled in the same household, and anyone else with a right to claim benefits under that policy. If PIP medical benefits are payable under two or more policies, they are payable only up to an aggregate equal to the highest single limit available.
What is the Michigan no-fault medical fee schedule and how much can providers be paid?
For treatment after July 1, 2021, MCL 500.3157 limits what providers can be paid under PIP to a percentage of Medicare. For treatment after July 1, 2023, the general limit is 190% of Medicare. Some providers, such as qualifying high-indigent-volume hospitals and certain rehabilitation facilities, have higher percentages, and ambulance emergency services are outside the schedule. The schedule has been held not to apply to treatment of people injured before June 11, 2019 under policies issued before that date (see Andary and Fremont).
Related Michigan pages
- Grand Rapids personal injury lawyer
- No-fault PIP
- No-fault work loss, attendant care and replacement services
- Who pays no-fault benefits and assigned claims
- No-fault claim denials
- Breach of contract
- Michigan legal FAQs
I represent people injured in Michigan crashes whose no-fault coverage level or medical bills are in dispute. Contact me 24/7 by phone or email. Your Rights, My Fight! Call for a free initial consultation.
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Law Offices of Mitchell S. Bisson, 2828 Kraft Ave SE, Suite 295, Grand Rapids, MI 49512, serving Kent County and West Michigan.
This page provides general information about Michigan law and is not legal advice. Reading it does not create an attorney-client relationship. Laws change and every case turns on its own facts. Consult a licensed attorney about your specific situation.