Michigan PIP: the fee schedule, attendant care limits and the MCCA

Since the 2019 reform, Michigan no-fault medical benefits are paid under three layers of rules: the PIP coverage level you chose, a fee schedule that caps what providers can be paid at a percentage of Medicare (190 percent for most providers and treatment after July 1, 2023), and a limit on in-home attendant care by family and friends set by reference to a 56-hour weekly cap. Behind unlimited coverage stands the Michigan Catastrophic Claims Association (MCCA), which reimburses insurers for very large claims and is paid for by a per-vehicle fee. Several parts of this system are still being argued in court as of November 2026.

This article walks through each layer using the statutes and court records themselves. It is general information; a claim in dispute belongs with a licensed Michigan attorney or the Department of Insurance and Financial Services (DIFS). For the big-picture overview, start with michigan's no-fault reform explained.

Layer one: the PIP medical coverage level you chose

Michigan's 2019 laws (2019 PA 21 and 22, effective June 11, 2019) ended the rule that everyone had unlimited lifetime medical benefits. For a policy issued or renewed after July 1, 2020, MCL 500.3107c requires the applicant or named insured to choose a coverage level for the medical and related PIP benefits listed in section 3107(1)(a), on a form approved by the DIFS director.

Some details from the statutes that decide how this works in practice:

• A choice covers the household. The level selected applies to the named insured, the spouse, resident relatives and anyone else with a right to claim PIP under the policy. If benefits are payable under two or more policies, they are payable only up to the highest limit available under any one of them.
• The default is unlimited. If a policy is issued or renewed without an effective selection, a rebuttable presumption says the premium paid reflects the coverage level; if that presumption does not apply, the policy provides unlimited coverage.
• Rideshare companies cannot pick the two lowest levels. A transportation network company vehicle must carry at least $250,000.
• The opt-out has a trap door. If the qualified health coverage ends during the policy term, the named insured must obtain PIP coverage within 30 days. An injury within that 30-day window, without other coverage, leaves the person with a claim under the assigned claims plan rather than PIP benefits.
• A rider fills the attendant care gap. An insurer must offer, on a policy with one of the three capped limits, a rider for attendant care above the applicable limit.

The practical consequence is that "PIP" now means different things on neighboring driveways. A $250,000 limit can be exhausted by a long hospital stay and rehabilitation; unlimited does not run out. For the larger decision of what to carry, see Personal injury protection (PIP) explained and the How much car insurance do I need?.

Layer two: the fee schedule

Before 2019, a provider could charge a reasonable amount and the insurer paid it. MCL 500.3157 now sets ceilings tied to what Medicare would pay for the same treatment. The ceiling applies to treatment or training rendered after July 1, 2021. It is a maximum, not a guarantee: subsection (1) still says the provider may charge a reasonable amount that does not exceed what the provider customarily charges for like treatment in cases that do not involve insurance.

The percentages

When Medicare has no payment amount for a service, subsection (7) uses a percentage of what the provider's charge description master (its gross billed charge list) showed on January 1, 2019, or of the average amount the provider charged that day. For most providers the percentages are 55, 54 and 52.5 percent in the three periods; for the second tier, 70, 68 and 66.5; for the highest tier, 78; and for trauma-center emergency care, 75, 73 and 71. Those 2019 baselines are then adjusted every year by the medical care component of the Consumer Price Index, and later changes in Medicare rates flow through, but a payment may not exceed the average amount charged on January 1, 2019. Ambulance operations providing emergency services are outside the schedule, and neurological rehabilitation clinics must be accredited by the Commission on Accreditation of Rehabilitation Facilities or a similar recognized body to be paid.

Worked example (invented numbers). Say Medicare would pay $1,000 for a therapy course and your provider bills $2,600. After July 1, 2023, a standard provider's ceiling is 190 percent, or $1,900. The insurer's obligation under the statute stops at $1,900 even though the bill was $2,600. If the same provider were a trauma center treating you before stabilization, the ceiling would be $2,300; for a service with no Medicare rate and a January 1, 2019 charge of $4,000, a standard provider's ceiling in the 52.5 percent period would be $2,100 before the annual price adjustment. The statute caps what the insurer must pay under the no-fault chapter. I did not verify whether and when a provider may bill a patient the difference, so ask your insurer and provider to explain in writing who bears any gap.

Where the fight is: what counts as "the amount payable under Medicare"

The statute says "Medicare" means the federal fee-for-service rate "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." That wording invites disputes over which Medicare adjustments insurers may apply. In Favot v. Brown, a published Court of Appeals opinion dated September 18, 2025, the court held that limitations such as the multiple-procedure payment reduction, Medicare's packaged-service rule, and geographic billing modifiers are "related" to the fee schedule's rates, so an insurer may use them; it described the statutory examples of "unrelated" limitations as utilization, readmissions, recaptures, bad debt and sequestration. It also noted that DIFS had issued two decisions in 2021 and 2022 finding Medicare rules did not apply in that way, and that courts give an agency's reading "respectful consideration" but are not bound by it. The court remanded for fact questions about how the reductions change the amount payable.

On June 18, 2026, the Michigan Supreme Court issued an order in the same case, directing oral argument on the application for leave to appeal and asking the parties to brief whether the Court of Appeals erred in finding that there are "related" limitations under section 3157(15)(f), and what the correct interpretation of "amount payable" is. As of November 2026 the answer has not issued, so how much of Medicare's fine print insurers can apply is unsettled. If a provider's payment looks lower than 190 percent of the base Medicare rate, ask the insurer which adjustments it used.

Layer three: attendant care limits

Attendant care is hands-on help with daily living: bathing, dressing, medication reminders, supervision. For many seriously injured people, family members provide most of it. Subsection (10) of MCL 500.3157 caps how much an insurer must pay when the care is provided in the injured person's home and is provided directly or indirectly by:

1. an individual related to the injured person;
2. an individual domiciled in the injured person's household; or
3. an individual with whom the injured person had a business or social relationship before the injury.

For those caregivers, the insurer is required to pay only up to the hourly limitation in section 315 of the workers' disability compensation act. MCL 418.315 says attendant or nursing care "shall not be ordered in excess of 56 hours per week" if provided by the employee's spouse, brother, sister, child, parent, or any combination of them. Subsection (11) of the PIP statute adds that an insurer "may contract to pay benefits for attendant care for more than the hourly limitation."

Worked example (invented numbers). Say an adult child needs help 12 hours a day, seven days a week, which is 84 hours, and the person's spouse and sister provide it. Under subsection (10), the insurer's obligation is 56 hours a week. The remaining 28 hours is not required unless the insurer agrees to more under subsection (11), the family hires help that is not related, domiciled in the household or previously acquainted, or the policy has an attendant care rider. The statute's wording shows that the cap turns on who delivers the care, not just on how much is needed: care by people outside the three categories is not named in subsection (10), although the phrase "indirectly through another person" means an arrangement run through a relative should be reviewed carefully. Ask the insurer in writing how it applies the cap and whether it will contract for more.

Because the reform was meant to apply prospectively, the dates matter. In *Andary v. USAA Casualty Insurance Co.*, decided July 31, 2023 by a 5-2 vote according to Claims Journal's report, the Michigan Supreme Court held that the 2019 amendments do not apply retroactively: insurers cannot cut fees or cap attendant care hours for people injured before the changes took effect. The Court also rejected a provider's argument that the changes were unconstitutional even for people injured after the law took effect, saying the schedules are rationally related to legitimate goals such as curbing PIP costs. Two justices dissented. The Claims Journal report adds that the Court of Appeals had said the earlier "reasonable charge" requirement still governs earlier injuries.

What the MCCA does and how it is paid for

The Michigan Catastrophic Claims Association is a nonprofit association created by MCL 500.3104. Every insurer writing the required security in Michigan must be a member. The MCCA is an insurer-to-insurer mechanism: you do not file a claim with it. Its website says it has operated since 1978, has provided about $25 billion in lifetime funding, and has had more than 49,000 catastrophic claims reported to it. The statute explains how the money flows:

• Reimbursement above a retention. For policies issued or renewed before July 2, 2020, and for policies with unlimited PIP issued or renewed after July 1, 2020, the MCCA indemnifies members for 100 percent of the ultimate loss under PIP coverages above a threshold per loss occurrence. For policies issued or renewed in the period from July 1, 2019 to June 30, 2021 that threshold is $580,000. Beginning July 1, 2021 it is raised every two years, on July 1 of each odd-numbered year, by the lesser of 6 percent or the Consumer Price Index, rounded to the nearest $5,000. I did not locate the current threshold figure, so ask your insurer or the MCCA for it.
• A per-car premium. The MCCA charges members an average premium per car for the expected losses and expenses of the association, including incurred-but-not-reported losses, adjusted for past excesses or deficiencies. Cars insured at $50,000, $250,000 or $500,000 limits, cars for which PIP was opted out, and cars excluded under section 3109a are left out of the average, except for any portion that adjusts for a deficiency in an earlier period. A historic vehicle is charged 20 percent of the usual amount.
• Deficiencies are spread out. The plan must require that a prior-period deficiency be amortized over not fewer than 15 years.
• Refunds. The statute lets the DIFS director order refunds to members, to be distributed to insureds.

The assessment is a line on your bill. The MCCA says insurers may pass it through, and that independent actuaries calculate it each year and DIFS reviews all changes. According to a compliance alert from the insurance data organization AAIS quoting the MCCA's notice to insurers, the assessment for July 1, 2026 to June 30, 2027 is $84 per vehicle for unlimited PIP ($65 pure premium and $19 deficit recoupment) and $19 per vehicle, deficit recoupment only, for all other PIP options including opt-outs. The MCCA's assessment page lists current and past rates, and its news feed reported on October 12, 2026 that the per-vehicle fee will drop next year; confirm the new figure there before relying on it.

Worked example. A household with two cars on the same policy and unlimited PIP is charged 2 x $84 = $168 in the 2026-27 period for the MCCA assessment. If it had chosen a capped limit, 2 x $19 = $38. The $130 difference is only the MCCA piece; the rest of the premium difference depends on each insurer's rates and your other characteristics.

The Michigan Automobile Insurance Placement Facility

The Facility is the safety net for drivers who cannot obtain coverage in the ordinary market. MCL 500.3301 says every insurer authorized to write automobile insurance in Michigan must participate in an organization that guarantees insurance is available "to any person who is unable to procure that insurance through ordinary methods," while preserving the benefits of price competition by encouraging maximum use of the normal private market. The organization is named the Michigan automobile insurance placement facility. Under section 3303, a "qualified applicant" is an owner or registrant of a Michigan-registered vehicle or a valid license holder, but not a person whose license is suspended or revoked (with listed exceptions), and not, in some circumstances, a person whose policy was cancelled for nonpayment within the preceding two years unless the premium installment is paid first. Insurers take shares of the business in proportion to their ordinary Michigan writings. The Facility is a placement mechanism; it is not part of the PIP medical rules, but it is the route when a driver with a poor history needs a policy that still includes PIP. See assigned risk plans: insurance of last resort and funds of last resort: assigned claims plans and judgment funds.

Checking whether your PIP claim is being paid correctly

1. Find your coverage level. Look at the declarations page and the signed selection form. Confirm that the level matches what you chose.
2. Request an explanation of benefits for each denied or reduced bill, showing the Medicare code or amount used and any adjustment.
3. Check the date of service. The ceilings apply to treatment after July 1, 2021, and the percentage depends on the period.
4. Ask which adjustments the insurer used (for example multiple-procedure reductions) and whether it believes they are "related" under section 3157(15)(f), given the pending Supreme Court review.
5. For attendant care, get the hours in writing. Ask whether the 56-hour cap is being applied, to which caregivers, and whether the insurer will agree to more.
6. Track deadlines and disputes. If benefits are denied, ask your insurer for the policy provision and contact DIFS or an attorney quickly. Related topics are in PIP and MedPay benefit cutoffs after an independent medical exam and PIP benefits explained: medical bills, lost wages and services.
7. Out-of-state crashes. Michigan PIP generally follows the policyholder; see accident in another state: whose insurance laws apply to your claim.

Common questions

Does the fee schedule mean my doctor can only be paid 190 percent of what Medicare pays?

For most providers and treatment after July 1, 2023, the maximum the no-fault insurer must pay is 190 percent of the Medicare amount, when Medicare has a rate. The statute lists other percentages for specific providers and a percentage of 2019 charges when there is no Medicare rate. The schedule limits the insurer's obligation under the no-fault chapter; it does not by itself say what a provider may do about the remainder.

Do these limits apply to a person injured before June 11, 2019?

Not under the Michigan Supreme Court's 2023 decision in Andary, as reported: the fee schedule and attendant care limits do not apply retroactively to people injured before the amendments took effect. The statute itself applies the fee schedule to treatment rendered after July 1, 2021, so the date of injury and the policy matter. Ask an attorney how this applies to a specific injury.

Who pays if my medical costs exceed my PIP limit?

Beyond a capped PIP limit, other sources may respond: health insurance, Medicare or Medicaid, or a claim against an at-fault driver for excess economic loss where the tort rules allow. Those are different systems with different rules; see who pays your medical bills after a car accident.

Is the MCCA fee the same as my PIP premium?

No. The MCCA assessment is a separate per-vehicle line item; your premium also includes the insurer's rate for PIP and every other coverage.

Key takeaways

• Michigan drivers choose a PIP medical limit ($50,000 for qualifying Medicaid enrollees, $250,000, $500,000 or unlimited) or, if they hold Medicare Parts A and B and meet household conditions, may opt out. The default is unlimited.
• Providers are paid no more than a set percentage of Medicare, 190 percent for most after July 1, 2023, with higher percentages for some hospitals and other providers and a fallback percentage of 2019 charges when Medicare has no rate.
• In-home attendant care by relatives, household members and prior acquaintances is capped at the 56-hour weekly workers' compensation limit unless the insurer agrees to more.
• The MCCA reimburses insurers above a retention and is funded by a per-vehicle fee, $84 for unlimited PIP and $19 otherwise for July 2026 to June 2027, with a lower fee reported for the next year.
• Whether insurers can apply Medicare's other payment adjustments is before the Michigan Supreme Court; under Andary, as reported, the 2019 changes do not reach people injured before they took effect.