When health care reform via the Health Insurance Marketplace was first introduced it included a fee called the Patient Centered Outcomes Research Institute Fee.  It was originally identified as a best practices panel that would be appointed to make sure finite health care dollars were wisely spent and not wasted on procedures that would not appreciably extend quality of life.  Immediately opponents identified it as a death panel that would ration healthcare.  Physicians can best answer if this is the case now that some of the higher cost specialties have had the government change how they practice medicine via quality measures.  In the meantime the fee or tax is still being collected to fund the PCORI.

The IRS has announced that the 2019 calendar plan year Patient-Centered Outcomes Research Institute Fee (PCORI) for the July 2020 filing will be $2.54 per covered individual (up from $2.45). 
 
As a reminder, health reimbursement arrangements (HRAs) are considered self-funded health plans and are therefore subject to the PCORI fee.

In IRS Notice 2020-44, the IRS has now released the fee for plan years ending on or after October 1, 2019 and before October 1, 2020, which includes 2019 calendar plan years that will report and pay the PCORI fee this July. 

For additional information and help determining your PCORI fee, check out this PCORI fee calculator here.

PIP (Personal Injury Protection) is one of the costs that made Michigan the most expensive auto insurance in the country.  Effective July 2nd drivers in Michigan will have additional options when choosing the level of PIP coverage they will have.  Seniors on Medicare will have the option of dropping PIP altogether.  In general we are recommending that seniors keep their full PIP coverage.  We can site an example for why this is a good idea but the coverage speaks for itself.

​Medicare is always considered a secondary payer in auto accidents and covers benefits subject to Medicare rules. Members will be required to pay their plan copays, if any.

There are many items covered under an auto policy’s medical coverage that Medicare does not cover, including, but not limited to:

• In-home attendant care
• Transportation to and from medical appointments
• Vehicle modifications
• Home modifications
• Replacement service
• Case management services
• Residential treatment programs
• Long-term comprehensive rehabilitation
• Electric wheelchairs
• Occupational therapy
• Executive functioning therapy for brain trauma

If Medicare pays for auto-related claims, Medicare can seek reimbursement from any settlement that a beneficiary receives for pain and suffering, thereby leaving less to compensate the beneficiary.