PIP coverage levels and the medical fee schedule in Michigan

Michigan personal protection insurance (PIP) pays for reasonably necessary medical care and rehabilitation, up to three years of lost income from work you would have done, up to $20 a day for replacement services for three years, and funeral expense up to the amount in the policy, which is between $1,750 and $5,000. PIP pays without regard to who caused the crash, subject to your policy's coverage level.

The core benefits are in MCL 500.3107. Allowable expenses are reasonable charges for reasonably necessary products, services and accommodations for your care, recovery or rehabilitation. A hospital room above a reasonable semiprivate rate is not covered unless you need special or intensive care. Work loss is income you would have earned in the first three years after the accident, and the statute reduces it by 15% for the tax advantage unless you prove a lower figure. A monthly maximum applies and is adjusted yearly, tied to the accident date. Replacement services pay for ordinary household tasks you can no longer do, at no more than $20 a day for three years. Whether a particular bill is payable also depends on the coverage level on the policy, the fee schedule in MCL 500.3157, and which insurer is first in line. It helps to start with the policy and the declarations page.

Authority: MCL 500.3107; MCL 500.3157. Reviewed Oct. 2026.

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.

Under MCL 500.3107c(1) the choices for allowable expenses are $50,000, $250,000, $500,000 or no limit, each per individual per loss occurrence. The insurer must use a form approved by the director that explains the benefits and risks and has to be signed by the applicant. The statute applies to policies issued or renewed after July 1, 2020, so an older policy that has not been renewed may be on a different footing. Insurers must also offer a rider for attendant care above the limit if you choose one of the capped levels. The limit covers allowable expenses under MCL 500.3107(1)(a), the medical category, rather than work loss or replacement services. If you cannot find your selection form, ask the insurer for the application and the signed election, and keep any premium notices that show the coverage tier. The tier is the ceiling on the no-fault safety net: once PIP medical benefits reach the limit they stop, and the remaining routes are an excess economic claim against an at-fault driver under MCL 500.3135(3)(c), health insurance, or an attendant care rider if you bought one.

Authority: MCL 500.3107c; MCL 500.3135; MCL 500.3107. Reviewed Oct. 2026.

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.

MCL 500.3107c(1)(a) sets two conditions that both have to be met. First, the applicant or named insured must be enrolled in Medicaid. Second, the applicant's spouse and any relative of either who lives in the same household must have qualified health coverage, be enrolled in Medicaid, or have coverage for the medical benefits under section 3107(1)(a) from an insurer that provides the required security. Qualified health coverage is defined in MCL 500.3107d. If a policy shows a $50,000 limit but these conditions were not met, whether the selection was effective becomes a question, and MCL 500.3107c(3) and (4) then control what level applies. The application, who lived in the home, and what coverage each person had on the date the policy was issued or renewed are the places to look.

Authority: MCL 500.3107c; MCL 500.3107d. Reviewed Oct. 2026.

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.

Having health insurance is not enough by itself, and the statute gives two routes. The first is the election in MCL 500.3107d. Under subsections (1), (7)(b)(ii) and (7)(c), the person making the election must have Medicare Parts A and B. The spouse and each resident relative need qualified health coverage, meaning Medicare Parts A and B or other health or accident coverage that does not exclude or limit motor vehicle injuries and has an annual deductible of $6,000 or less per person (as adjusted), or they need PIP medical coverage from an insurer. The election applies to the named insured, spouse, resident relatives and anyone else who would have claimed under the policy. The second route is the exclusion in MCL 500.3109a(2). 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, the spouse and the relatives domiciled in the household all have qualified health coverage, the premium for PIP medical benefits is reduced 100%, and a person subject to the exclusion is not eligible for PIP benefits under the policy. Under either route, if the qualifying coverage ends, the named insured has 30 days to obtain insurance that includes PIP medical coverage. For the election, if the named insured does not, a person covered by the election who is injured within that 30-day period, and is not covered under some other policy, is not entitled to PIP medical benefits under the policy but may claim through the assigned claims plan (MCL 500.3107d(6)(c)). For the exclusion, an excluded person injured during the 30 days may claim through the plan (MCL 500.3109a(2)(d)(ii)), and if coverage is not obtained in that period, an injured person with no other policy is not entitled to PIP medical benefits for an injury that occurred while the exclusion applied (subsection (2)(e)). The election form must also warn that a person who does not obtain coverage within the 30 days is excluded from PIP medical benefits for the period coverage was not maintained (MCL 500.3107d(3)(e)). An ineffective election defaults to unlimited coverage under subsection (4). When an election or exclusion applies, MCL 500.3135(3)(c) also preserves a claim against an at-fault driver for allowable expenses without limit, subject to the fault rules in that section.

Authority: MCL 500.3107d; MCL 500.3109a; MCL 500.3135. Reviewed Oct. 2026.

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.

MCL 500.3107c(3) and (4) answer this. When the named insured has not made an effective selection but a premium or installment has been paid, there is a rebuttable presumption that the premium paid accurately reflects the level of coverage. If no effective selection was made and that presumption does not apply, the policy falls to the no-limit level in subsection (1)(d). What counts as an effective selection is tied to the form requirements in subsection (2): conspicuous disclosure of benefits and risks, an acknowledgment, a way to mark the choice, and a signature. Because the presumption can be rebutted with other evidence, the application, the renewal packets, the premium history and any e-signature records should be gathered before anyone says what limit applies.

Authority: MCL 500.3107c. Reviewed Oct. 2026.

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.

MCL 500.3107c(5) says the selected level applies to the named insured, the named insured's spouse, a relative of either domiciled in the same household, and any other person with a right to claim PIP under the policy. Subsection (6) addresses stacking: 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 the policies. That means you cannot add a $250,000 limit to a $500,000 limit to reach $750,000. Priority among insurers is a separate question under MCL 500.3114. A related point is that a limit applies per person per loss occurrence, so each injured family member has their own limit for the same crash. Who is named, who was domiciled in the home, and every policy that might apply should be checked before adding up the coverage. Domicile generally means where a person has a settled, permanent home, and it is decided on the facts.

Authority: MCL 500.3107c; MCL 500.3114. Reviewed Oct. 2026.

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).

The schedule in MCL 500.3157(2) reduced over time: 200% of Medicare for treatment from July 2, 2021 through July 1, 2022, 195% the next year, and 190% for treatment after July 1, 2023. Subsection (3) sets a higher ceiling for providers with 20% to under 30% indigent volume and for up to two designated freestanding rehabilitation facilities: 230%, then 225%, then 220% for treatment after July 1, 2023. Under subsection (5), a provider with 30% or more indigent volume gets 250% of Medicare instead. Level I and level II trauma centers have a separate ceiling under subsection (6) for emergency care before the patient is stabilized and transferred: 240%, then 235%, then 230% for treatment after July 1, 2023. If Medicare has no rate for a service, subsection (7) uses a percentage of the provider's January 1, 2019 charge description master, which is 52.5% for the general tier after July 1, 2023. Subsection (13) takes emergency medical services by an ambulance operation out of the schedule, and subsection (14) says subsections (2) to (13) apply to treatment rendered after July 1, 2021. Those dates do not settle every case. In Andary v USAA Cas Ins Co, 512 Mich 207 (2023), the Supreme Court held 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 applied that reasoning to the other amended fee schedule provisions for an accident before that date under an older policy. Further review of that decision is possible, so its current status should be confirmed before relying on it.

Authority: MCL 500.3157; Andary v USAA Cas Ins Co, 512 Mich 207 (2023); Fremont Ins Co v Lighthouse Outpatient Ctr, No. 370500 (Mich Ct App Apr 11, 2025). Reviewed Oct. 2026.

Generally not, for an insured injured under a policy issued before June 11, 2019. In Andary v USAA, the Michigan Supreme Court held that the scope of PIP benefits vests when you are injured, and that MCL 500.3157(7), the fallback fee schedule rule, and 3157(10), the family attendant care limit, do not apply to an insured who was injured while covered by a policy issued before June 11, 2019. In Fremont v Lighthouse Outpatient Center (2025), a published Court of Appeals decision, the court applied the same reasoning to the rest of the fee schedule. Both cases involved people directly covered by a no-fault policy.

Andary v USAA Casualty Ins Co, 512 Mich 207 (2023), reasoned that PIP benefits have both statutory and contractual characteristics and that their scope vests at the time of injury, so the Legislature's 2019 limits did not clearly reach people already injured under older policies. The Court decided only subsections (7) and (10) of MCL 500.3157, and it described its holding in terms of an insured covered by a no-fault policy. It did not decide whether someone with only a statutory claim, such as under MCL 500.3114(4) or 500.3115, gets the same protection. 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 Andary's reasoning is not limited to subsections (7) and (10) and applies to the other amended fee schedule provisions for an accident before June 11, 2019 under a policy issued before that date. The court rejected the narrower reading of Andary taken by the Department of Insurance and Financial Services. So three dates matter: the injury, the date the policy in force was issued, and the dates of service at issue. Fremont is a Court of Appeals decision, so further review is possible, and its current status should be confirmed before relying on it for a specific point.

Authority: Andary v USAA Cas Ins Co, 512 Mich 207 (2023); Fremont Ins Co v Lighthouse Outpatient Ctr, No. 370500 (Mich Ct App Apr 11, 2025); MCL 500.3157; MCL 500.3114. Reviewed Oct. 2026.

Yes, but for in-home care provided by a relative, a household member, or someone with a prior business or social relationship, MCL 500.3157(10) limits the insurer's required payment to the hourly limit in the workers' compensation act. That act caps care by a spouse, sibling, child or parent at 56 hours a week. An insurer may agree to pay more by contract.

MCL 500.3157(10) applies when attendant care is rendered in the injured person's home and provided directly or indirectly by a related individual, a person domiciled in the household, or a person who had a business or social relationship with the injured person before the injury. In that case the insurer need only pay up to the hourly limitation in MCL 418.315, which says attendant or nursing care is not ordered above 56 hours per week when provided by the employee's spouse, brother, sister, child, parent, or any combination of them. Subsection (11) says an insurer may contract to pay more. These limits apply to treatment after July 1, 2021, and, per Andary, they do not apply to an insured who was injured while covered by a policy issued before June 11, 2019. The coverage level on the policy is a separate limit, and an attendant care rider may be available above a capped level under MCL 500.3107c(8).

Authority: MCL 500.3157; MCL 418.315; Andary v USAA Cas Ins Co, 512 Mich 207 (2023); MCL 500.3107c. Reviewed Oct. 2026.