Does Medicare Cover Injuries From a Car Accident?
Medicare Benefits Solutions
Jan 10, 2023
Medicare benefits may help cover injuries sustained as a result of an auto accident. But only as a secondary payer. In other words, you must first use all coverage and benefits provided by your car insurance company before Medicare would pay any benefits.
How Does Medicare Cover Car Accident Injuries?
There are millions of car accidents every year in the United States. If you’re injured as the result of a car accident and require medical attention, the cost of your care should be the last thing on your mind. If you have Medicare, you have access to healthcare coverage for medically necessary services and supplies, including urgent care.
Depending on the severity of your accident, your personal needs, and your location, you may need access to different types of care. If you have a mild injury, you may visit a doctor hours, days, or even weeks later. If it’s more serious, you may need immediate emergency room care, an ambulance, or even air transportation depending on the location of your incident.
Once you’ve been taken care of, you may wonder if your medical expenses will be covered by your Medicare health insurance or if you need to file a claim with your auto insurance carrier.
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Does Your Health Insurance Cover Car Accidents?
Health insurance covers medical expenses except for work-related illnesses and injuries. For example, if you are injured in a car accident while traveling on business, you would report the accident to your employer and file a worker’s compensation claim to cover your medical expenses.
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Understanding Coordination of Healthcare Benefits
Understanding the coordination of benefits helps to answer the question, does Medicare cover car accident injuries? Coordination of benefits is a rule that designates one insurer as the primary payer and the other as the secondary or supplemental payer. Within coverage parameters, the primary payer pays first. The secondary payer covers unpaid expenses based on your benefits.
If you have no-fault insurance, your auto insurance carrier is the primary payer, and Medicare is secondary. Medicare becomes primary if the insurance company is not liable or denies your claim. Medicare’s responsibility is limited to Medicare-covered services. You are still responsible for any applicable deductible, coinsurance and copayments.
Medicare and Auto Accident Settlements
If you have no-fault insurance, your doctor should bill the auto insurance company first. If the insurance company does not pay within 120 days, the provider may invoice Medicare. Medicare may then issue a conditional payment and recover it later.
If you receive an auto accident settlement from your car insurance company, you must repay Medicare for the benefits received. You are required to call the Benefits Coordination & Recovery Center to report your claim and the settlement payout. The phone number is 1-855-798-2627. The center will calculate the final amount that needs to be recovered and mail you a letter requesting repayment.
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What Does Medicare Cover for Auto Accidents?
Original Medicare covers inpatient and outpatient medical expenses. If you have Medicare Part D drug coverage, your benefits include prescription medications in your plan’s formulary (list of approved drugs).
Medigap, or Medicare Supplement, policyholders get help with certain out-of-pocket costs. Plans C and F cover 100% of the Plan B deductible. All Medicare Supplement plans cover inpatient coinsurance and hospital costs, extending beyond Original Medicare limits. Supplemental plans cover some or all of the Part B coinsurance and copayments.
Medicare Advantage members get Original Medicare benefits and more. Your out-of-pocket costs can differ from Original Medicare, and your provider options may be limited to the plan’s provider network. But your plan may include prescription drug coverage and extra benefits.
Some Medicare Advantage plans include transportation to office visits if you cannot drive after your accident. You may get access to over-the-counter products at no cost within a specified allowance amount. Items can include nonprescription medication for pain relief, bandages and assistive products like canes.
Are Auto Accident Injuries Covered Under Part A or B?
Part B covers ambulance and emergency department services. After you meet your Part B deductible, Medicare pays 80% of the Medicare-approved amount. The emergency room (ER) usually charges a copayment. If the hospital admits you, the ER charges may change.
As an inpatient, Part A covers a semi-private hospital room, all meals, general nursing services, medication, and other inpatient services and supplies. You are responsible for the Part A deductible. If the hospital discharges you within 60 days, no coinsurance is due.
If you need blood and the hospital can’t get it free from a blood bank, Medicare covers the cost after the first three pints. After your hospital stay, you may need rehabilitation. If you qualify for admission to a skilled nursing facility, Medicare covers the first 20 days. If you require more than 20 days of inpatient care and therapy, you are responsible for coinsurance for up to 100 days. After 100 days, you pay the costs in full.
When you return home, Medicare covers home health services if needed. You incur no cost for medically necessary home healthcare ordered by your doctor and provided by a Medicare-certified home health agency. Part B covers durable medical equipment for home use, such as hospital beds, and outpatient services, including visits to your doctor and physical therapy. The Part B deductible and coinsurance apply.
No-fault Auto Insurance
In no-fault states, drivers need to buy personal injury protection (PIP), a component of auto insurance coverage that covers medical expenses for policyholders and passengers regardless of fault. No-fault policies cover a policyholder’s medical bills for injuries resulting from a car accident, regardless of who is at fault. Drivers recover the cost of their medical expenses through their own insurance coverage, restricting the right to sue the party at fault unless injuries exceed a specific threshold.
There are many variations across the states on no-fault insurance laws, ranging from mandatory no-fault and choice no-fault to tort liability (no lawsuit restrictions). Inquire with your state insurance department or local motor vehicle agency to confirm if no-fault insurance is mandatory or optional in your state.
Healthcare After a Car Accident
If you’ve been hurt in a car accident, the most important thing is to focus on your health and recovery. If you have questions about the cost of your care, talk to your insurance agents and check with your Medicare plan directly.
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