Understanding the intersection between workers' comp and Medicare: Essential insights explained
Going Public with Your Workers' Compensation Case
Navigating the interplay between workers' compensation and Medicare isn't always straightforward. With the wrong move, you could face claim denials and the obligation to repay Medicare.
Workers' compensation serves as a safety net for employees who have suffered job-related injuries or illnesses. The Office of Workers' Compensation Programs (OWCP), under the Department of Labor, oversees this benefit for federal employees, their families, and selected entities.
If you're currently on Medicare or are about to join, it's essential to be in the know about how your workers' compensation benefits might impact Medicare's coverage for your medical claims. This understanding can help you avoid pitfalls in managing medical costs for job-related injuries or illnesses.
The Nitty-Gritty of Workers' Comp Settlements & Medicare
Under Medicare's secondary payer policy, workers' compensation should foot the bill for any treatment related to a work-related injury. However, if immediate medical expenses emerge before you receive your workers' compensation settlement, Medicare might pay first, kicking off a recovery process managed by the Benefits Coordination & Recovery Center (BCRC).
To evade a recovery process and keep things smooth, the Centers for Medicare & Medicaid Services (CMS) tends to keep tabs on the amount you receive from workers' compensation for medical care related to your injury or illness. In some cases, Medicare may request the establishment of a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds. Medicare will cover your care only after all the money in the WCMSA is exhausted.
Mandated Disclosures
When it comes to workers' compensation settlements, the amount over $25,000 needs to be reported to CMS. This requirement applies to cases where you are already enrolled in Medicare based on age or Social Security Disability Insurance (SSDI) or where you will qualify for Medicare within 30 months of the settlement date and the settlement amount is $250,000 or more.
On top of workers' comp, you must report to Medicare if you file a liability or no-fault insurance claim.
Frequent Questions
You can reach out to Medicare by phone at 800-MEDICARE (800-633-4227, TTY 877-486-2048) or through a live chat on Medicare.gov during specific hours. For questions regarding the Medicare recovery process, you can contact the BCRC at 855-798-2627 (TTY 855-797-2627).
The Lowdown
Workers' compensation is a crucial safety net for federal employees and other designated groups dealing with job-related injuries or illnesses.
To avoid problems with medical expenses and ensure your Medicare coverage is sorted, it's important to be well-informed about how workers' compensation may impact your Medicare coverage and to report your workers' compensation agreements to Medicare. Failure to do so could lead to future claim rejections and reimbursement obligations.
For more resources to help you navigate the complex world of medical insurance, visit our Medicare hub.
- In the realm of health systems and health-and-wellness, it's vital for individuals currently on Medicare or approaching Medicare eligibility to understand the impact of workers' compensation benefits on Medicare's coverage for medical claims related to job-related injuries or illnesses.
- Under the Medicare secondary payer policy, workers' compensation should cover any treatment related to a work-related injury, but in some cases, Medicare may request the creation of a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds, requiring exhaustion of the WCMSA before covering the care.
- When a workers' compensation settlement exceeds $25,000 or if the individual is enrolled in Medicare based on age or SSDI and is expected to qualify for Medicare within 30 months of the settlement date, the settlement amount must be reported to Centers for Medicare & Medicaid Services (CMS), as well as any liability or no-fault insurance claims.
