Effect of Medicare Part C coverage; “Qualified person” under MCL 500.3107d; Opting out of personal injury protection (PIP) benefits to reduce premium payments; Whether the Medicare Advantage Plan was “qualified health coverage” under MCL 500.3107d(7)(b)(ii); Commonwealth ex rel Kane v UPMC (PA); Medicare Advantage Organizations (MAO)

The court concluded the trial court did not err in holding that nonparty-Seguna “was a qualified person under MCL 500.3107d, and that he effectively opted out of PIP coverage benefits to reduce his premium payments.” The claim arose from injuries sustained in a motor vehicle accident where he lost control of his vehicle. Plaintiff-University Neurosurgical Associates argued that the trial court erred when it held “that Seguna’s Medicare Part C coverage met the statutory definition of ‘qualified health coverage,’” and that he “effectively elected to opt out of PIP medical coverage.” Specifically, plaintiff argued “that while MCL 500.3107d unambiguously identifies Parts A and B of the Medicare program, the statute does not mention Medicare Part C as meeting the statutory definition of qualified health coverage. Because the Medicare Advantage Plan through Blue Cross was under Part C, plaintiff argues that Seguna was not a qualified person who was eligible to opt out.” The court held that contrary “to plaintiff’s interpretation of MCL 500.3107d, a Medicare Advantage Plan obtained under Part C of Medicare is qualified health coverage under the statute since Medicare Advantage Plans provide coverage for services required under Medicare Parts A and B, albeit through a private health insurance company.” It concluded that “a person like Seguna who is enrolled under Part C receives the benefits that are required under Parts A and B, but just not directly from the government.” The court further determined that it “is true, as plaintiff argues, that Parts A, B, and C are separate statutory parts, and that the benefits available under both Parts A and B are paid for by the government, while Part C benefits are paid for by an MAO. And, it is equally true that Seguna did not elect to receive benefits directly from the government under either Part A or B, instead choosing to receive those benefits under Part C through Blue Cross.” But, as defendants argued, the dispositive question was “not whether Seguna elected to receive benefits under Parts A and B (and have them paid by the government), but whether he was receiving the benefits provided ‘under’ Parts A and B of the Medicare statute.” And, as the Pennsylvania Supreme Court recognized in Commonwealth ex rel Kane, “in the view of the federal government, if an individual is enrolled in [a] Medicare Advantage program, that individual is still considered to be in the federal Medicare program. As such, a person who is enrolled in Medicare Advantage receives their Medicare Part A and B benefits through the Medicare Advantage program.” The court held that when “Seguna filled out the waiver form, he provided proof that he had a Medicare Advantage Plan, which qualified as health coverage, because Seguna’s plan provided him with coverage for the benefits required under Medicare Parts A and B, albeit through a private health insurance company under Part C. Thus, Seguna effectively opted out as permitted under MCL 500.3107d.”