Does Medicare Cover Car Accident Injuries?

A black car with a smashed windshield after an accident with a van.

Medicare is a federal health insurance program that provides coverage for eligible individuals who are 65 years of age or older, as well as for individuals with certain disabilities and medical conditions.

If you are injured in a car accident and have Medicare coverage, your medical expenses may be covered by Medicare. However, Medicare is a secondary payer, which means that it will only pay for your medical expenses after other sources of payment have been exhausted.

So if you’ve been injured in a car accident and need advice on how to proceed with legal action, reach out to Singh Ahluwalia Attorneys at Law today. Our team of qualified personal injury lawyers can help you navigate the immediate next steps after your accident.

We protect your rights when it comes time to negotiate with an intimidating insurance company or rival legal team. To schedule your first appointment, simply call (559) 878-4958 or contact the team online.

How Much Will Medicare Take From My Settlement?

If you receive a settlement after filing a successful personal injury lawsuit, Medicare may be entitled to a portion of these winnings.

Specifically, if you were in a car accident and Medicare paid for any expenses you incurred after getting injured in the accident, their team is legally entitled to reimbursement for the medical expenses they paid for. 

The amount that Medicare will take from your settlement or award will depend on several factors, including the total amount of your settlement or award, the amount of medical expenses Medicare paid after the accident, and whether you have hired an attorney to represent you.

Under federal law, Medicare has a right to recover the full amount of its payments (related to the accident). However, Medicare may reduce this recovery amount based on certain factors, such as the attorney’s fees and costs associated with obtaining the actual settlement or award.

In some cases, Medicare may also reduce its recovery amount if the settlement or award is less than the total amount of damages that you suffered in the accident.

What Is Medicare’s Benefits Coordination & Recovery Center (BCRC)? 

The Medicare BCRC is a division of the Centers for Medicare & Medicaid Services (CMS) that is responsible for identifying and recovering payments that Medicare made for medical expenses related to a personal injury or illness that may be the responsibility of another party.

This means they deal with insurance companies, liability insurers, or workers’ compensation programs.

The BCRC receives information about potential liability insurance, no-fault insurance, or workers’ compensation cases from Medicare beneficiaries, healthcare providers, attorneys, and insurance companies.

The BCRC then works to identify whether Medicare has made payments related to the claim and if so, how to recover those payments from the responsible party or parties.

If the BCRC is seeking reimbursement from your personal injury settlement, it may be in your best interest to consult with an experienced personal injury attorney. The reimbursement process can be complex, and an attorney can help you understand your rights and options.

Good lawyers can negotiate with the BCRC on your behalf to ensure that you are not paying more than what is legally required.

What’s the Difference Between Medicare Part A vs. Medicare Part B?

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. If you are involved in a car accident and require hospitalization, Medicare Part A will cover the hospitalization expenses.

Part A usually includes room and board, as well as any necessary medical procedures and treatments.

Medicare Part B covers outpatient medical services, such as doctor visits, preventive care, diagnostic tests, and durable medical equipment. If you require additional medical treatment, such as physician visits or physical therapy, Medicare Part B may cover those expenses.

It’s important to note that Medicare Part B coverage is technically optional and comes with a monthly premium. The amount of this premium will vary depending on your income level, but in 2023, the standard monthly premium for Medicare Part B will be $164.90.

That said, if your income is above a certain threshold, you may be required to pay a higher premium.

With Medicare, How Much Will I Pay For Medical Care After a Car Accident? 

The cost of treating your car accident injuries with Medicare can vary widely depending on the nature and severity of your injuries, the type of treatment you require, and your specific Medicare coverage.

If you have Medicare Part A coverage, your hospitalization and inpatient care related to the car accident will be covered, but you may be responsible for deductibles, co-payments, or other out-of-pocket costs.

For example, in 2023, the Medicare Part A deductible for hospitalization is $1,608 per benefit period (as of writing), and if your hospital stay exceeds a certain length, you may also be responsible for daily co-payments.

Similarly, with Medicare Part B, the annual deductible was $233 per year in 2023. So if you require outpatient services, you’ll initially be required to meet your deductible.

After that, you’ll be responsible for paying a cost share of 20% of the Medicare-approved amount tied to your specific services. 

Notably, ambulance services are also covered under Medicare Part B, but typically only up to 80%.

This means that you may be left paying the 20% coinsurance portion, and you could also be held responsible for covering other expenses like mileage fees or for the use of oxygen or other specialized equipment. 

What Happens if I’m in a Car Accident and I Only Have Medicare Part A Coverage? 

If you are involved in a car accident and only have Medicare Part A coverage, your coverage will be limited to inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.

If you require outpatient medical services like doctor visits or physical therapy, these services may not be covered.

In this case, you may be responsible for paying for those services out of pocket, or you may need to seek coverage from another source, such as through a liability claim against an at-fault driver, private health insurance, or Medicaid.

What Should I Do In This Situation If I Was Not At-Fault In The Car Accident? 

If you were not at fault in a car accident and have only Medicare Part A coverage, there are several steps you can take to seek coverage for your car accident-related medical expenses:

  1. Seek medical attention as soon as possible: It’s important to seek medical attention as soon as possible after a car accident, even if you feel fine. This can help you identify any lingering injuries that you may not notice right away and will also provide early documentation of your injuries if you decide to pursue legal action down the line. 
  2. Contact your insurance provider: If you have private health insurance, contact your provider to see if your policy covers car accident-related injuries. If so, provide them with documentation of the accident and your medical treatment.
  3. Consider filing a personal injury claim  If you were not at fault in the car accident, you may be able to file a personal injury claim against the at-fault driver’s insurance company to seek compensation for your medical expenses, lost wages, and other damages. An experienced personal injury attorney can help you understand your legal options and navigate the claims process.
  4. Work with your healthcare provider: Your healthcare provider can help you understand your treatment options and work with you to develop a care plan that meets your needs (and fits within your coverage limitations).
  5. Keep detailed records: Keep detailed records of your medical treatment and expenses, as well as any communications with insurance providers or attorneys. This documentation can help you build a strong case for ample coverage and compensation.

How Can I Prevent Medicare From Taking Money Out of My Car Accident Settlement? 

If you believe you’ll require long-term, ongoing care, you might want to consider setting up a Medicare Set-Aside (MSA) account. This is a specific type of trust account designed to hold a portion of your settlement proceeds.

In the future, when it comes time to pay out for additional medical expenses related to your accident, you’ll be able to tap into this account.

However, if you cannot afford to pay out the medical expenses you’ve already incurred or need the money to cover additional damages, your best course of action will be to call an attorney.

The right car accident lawyer can make all the difference when it comes to negotiating with Medicare reps, as they’ll be able to confidently fight for your rights with ease. 

So if you’re looking to find a strong car accident law firm in Fresno and throughout California, contact Singh Ahluwalia Attorneys at Law today.  Their team is here to help you defend your case — and settlement — and are just one call away. To schedule your first appointment, simply call (559) 878-4958 or contact the team online.