Massachusetts PIP: How Health Insurance and Deductibles Change What You Get

By the FigureMyTax Editorial Team · How we calculate

In Massachusetts, PIP pays no more than $2,000 of medical expenses that your health, sickness or disability insurance pays, and a policyholder may elect a PIP deduction of $100, $250, $500, $1,000, $2,000, $4,000 or $8,000.

Health insurance pays first

M.G.L. c. 90, 34A says PIP shall not provide for payment of more than $2,000 of expenses incurred within two years of the accident for medical, surgical, x-ray and dental services, prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services if, and to the extent that, they have been or will be compensated, paid or indemnified under a health, sickness or disability insurance policy or a similar contract. Your health policy may not deny coverage because PIP exists.

Limited reimbursement to the health insurer

The entity that pays or reimburses those expenses may not recover from you, or be subrogated to your rights, for more than $2,000 of PIP benefits, and may not have a lien against your PIP benefits.

Keeping the policy alive

Within two years of the accident, if you cannot pay to renew a health or income disability policy, the PIP insurer may tender the cost of keeping it in force for the two-year period, and you must then continue the policy.

Deductible options

Under section 34M, each PIP insurer must issue, at the policyholder's option, an endorsement deducting $100, $250, $500, $1,000, $2,000, $4,000 or $8,000 from amounts otherwise due the policyholder alone or the policyholder and household members. Anyone subject to the deduction has no right to recover the deducted amount from an exempt owner, registrant, operator or occupant.

A worked example

With $6,000 of medical bills paid by health insurance and $2,400 of wage loss, PIP pays $2,000 of the medical bills plus $2,400, or $4,400. With a $1,000 deduction, it pays $3,400. The deduction does not change whether you exceed the $2,000 threshold. Use the Massachusetts no-fault calculator and read the threshold post.

Other claims on a settlement

Health plans may have their own reimbursement rights against a tort recovery; see Massachusetts medical liens.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Massachusetts's rules apply to your specific case with a licensed Massachusetts attorney.