Understanding Interplay between Workers' Compensation and Medicare: Key Points to Consider
Getting the Most Out of Your Workers' Comp and Medicare:
Navigating the interplay between workers' compensation and Medicare isn't always a walk in the park. But with the rightinfo, you can ensure your medical bills and coverage are handled efficiently.
Workers' Comp - The Boss of Work-Related Injuries
Workers' compensation is a beast specific to federal employees and certain entities where it covers job-related injuries and illnesses. The Office of Workers’ Compensation Programs (OWCP) under the Department of Labor handles this program.
The Workers' Comp-Medicare Dance-Off
When it comes to medical bills, Medicare takes a backseat to workers' compensation for work-related injuries. However, if Medicare shells out the cash before the workers' compensation settlement arrives, they may jump into recovery mode.
In those situations, the Centers for Medicare & Medicaid Services (CMS) keeps an eye on the amount paid for injury or illness-related medical care from the workers' comp settlement. If there's a need, Medicare might ask for a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) to ensure they cover medical costs after the WCMSA funds run dry.
** bills that need to be reported**
When a workers' compensation settlement hits the $25,000 mark for Medicare beneficiaries or $250,000 for those who'll be eligible within 30 months, it's time to spill the beans to Medicare.
In addition, if you file a liability or no-fault insurance claim, throw that on the pile too.
FAQ Section
Got questions? Dial 800-MEDICARE (800-633-4227, TTY 877-486-2048) or hit up the live chat on Medicare.gov during select hours. If you're curious about the Medicare recovery process, the Benefits Coordination & Recovery Center (BCRC) is your go-to at 855-798-2627 (TTY 855-797-2627).
Let's Get Technical
A WCMSA is optional, but if you're a Medicare beneficiary and your workers' comp settlement is over $25,000, you may want to consider creating one.
Stashing away WCMSA funds for future medical expenses related to the injury is a wise move, but remember, those funds are off-limits for other purposes. Misuse could result in claim rejections and a bill from Medicare.
The Bottom Line
Don't let workers' compensation and Medicare leave you feeling scratched and confused. Brush up on the ins and outs of workers' compensation to avoid complications, prevent costly mistakes, and keep your medical bills in check.
Medicare resources
Looking for more medical insurance guidance? Check out our Medicare hub for resources that'll help you unravel the tangled Medicare web.
- The Centers for Medicare & Medicaid Services (CMS) might require a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) to cover medical costs after the WCMSA funds run dry, if Medicare has paid for injury or illness-related medical care and there's a need.
- If a workers' compensation settlement exceeds $25,000 for Medicare beneficiaries or $250,000 for those who will be eligible within 30 months, it is essential to inform Medicare about the settlement, along with any liability or no-fault insurance claims.
- Medicare resources can be found in the Medicare hub, which offers valuable guidance to help individuals unravel complicated aspects of Medicare, health systems, and health-and-wellness, including therapies-and-treatments and nutrition.
- In situations where a workers' compensation case involves Medicare, creating a WCMSA might be beneficial for Medicare beneficiaries, as it provides a dedicated fund for future injury-related medical expenses, avoiding potential rejections and billing issues down the line.
