Understanding Interplay Between Workers' Compensation and Medicare: Crucial Insights
Navigating the labyrinth of Medicare and workers' compensation is a must for anyone involved in these systems. Here's the lowdown:
Wrangling Medicare and Workers' Compensation
Workers' comp is a lifesaver for employees who get injured or sickened on the job. The Office of Workers' Compensation Programs (OWCP) under the Department of Labor oversees this benefit for federal employees, their families, and certain others.
In case you're dual-enrolled in Medicare, understanding how workers' comp affects Medicare coverage is crucial to avoid headaches over medical costs associated with work-related injuries.
Settlements and Medicare: What's the Big Deal?
Medicare's secondary payer policy means workers' comp should foot the bill for work-related injury treatment before Medicare steps in. However, if expenses pop up prior to the settlement arriving, Medicare might pony up first, initiating a recovery process managed by the Benefits Coordination & Recovery Center (BCRC).
To sidestep the recovery process, the Centers for Medicare & Medicaid Services (CMS) eyeballs the amount a person receives from workers' comp for injury-related care. In some cases, Medicare may ask for a workers' compensation Medicare set-aside arrangement (WCMSA) to hold these funds. Medicare won't cover care until the WCMSA money runs dry.
Should I Tattle on My Settlement to Medicare?
In a word, yes! Workers' comp needs to submit a total payment obligation to the claimant (TPOC) to CMS if the settlement is $25,000 or more for someone already enrolled in Medicare or qualifying within 30 months. Additionally, TPOCs are necessary if the person is not yet enrolled but will qualify within 30 months and the settlement is $250,000 or more.
Plus, don't forget to report liability or no-fault insurance claims to Medicare, too.
FAQs
Reach out to Medicare with questions by phoning 800-MEDICARE (800-633-4227, TTY 877-486-2048) or using Medicare.gov's live chat feature (available during certain hours). For questions about the Medicare recovery process, dial 855-798-2627 (TTY 855-797-2627) and chat with the BCRC.
A WCMSA is optional, but if you're hoping to create one, the settlement must exceed $25,000 or $250,000 within 30 months of eligibility.
Misusing WCMSA funds for anything other than intended expenses is a no-no, as it could lead to claim denials and the need to reimburse Medicare.
In closing
Workers' comp is a safety net for job-related injuries and illnesses for federal workers and associated groups. Educate yourself about how workers' comp affects Medicare to skip complications with medical expenses.
Remember to promptly report workers' comp agreements to Medicare to dodge future claim rejections and reimbursement obligations.
Medicare Resources
For additional resources to navigate the hazy world of medical insurance, check out our Medicare hub.
- For those with both Medicare and a workers' compensation system, it's essential to comprehend how the two intertwine to prevent unexpected medical expenses related to work-related injuries.
- In situations where Medicare is the secondary payer for work-related injury treatment, it's important to be mindful of the amount received from workers' compensation, as Medicare may ask for a Medicare set-aside arrangement (WCMSA) to manage funds earmarked for injury-related care.
- If a workers' compensation settlement surpasses $25,000 for those already enrolled in Medicare or qualifying within 30 months, or $250,000 for future enrollees within the same time frame, it should be reported to Medicare.
- Furthermore, don't forget to report any liability or no-fault insurance claims to Medicare, in addition to workers' comp settlements.
