Medicare and workers' compensation: Important information to understand
Navigating workers' comp and Medicare doesn't have to be a headache. Here's the lowdown:
When you're injured on the job as a federal employee or part of an eligible group, workers' comp kicks in. But things get dicey when Medicare's involved. Here's why:
When Workers' Comp Settlements Collide with Medicare
Medicare plays second fiddle to workers' comp when it comes to paying for work-related injury treatment. However, if expenses pop up before you receive your workers' comp settlement, Medicare might foot the bill initially. But don't worry — they'll eventually try to get that cash back.
To skip the recovery process and keep things straightforward, the Centers for Medicare & Medicaid Services (CMS) likes to keep tabs on how much you get from workers' comp for your injury-related medical bills. In some cases, they'll even ask for a workers' comp Medicare set-aside arrangement (WCMSA) — they'll only cover your care after the WCMSA's funds are spent.
Settlements That Need Reporting to Medicare
If you're already on Medicare or are soon to join the club, it's crucial to understand how your workers' comp benefits might impact Medicare's coverage of your medical claims. You've got to report certain settlements to Medicare:
- If your workers' comp settlement is $25,000 or more and you're either already on Medicare or struggling to get there within 30 months, you've got to let CMS know about it.
- Same goes if you're not on Medicare yet but will be within the next 30 months and your settlement is $250,000 or more.
And don't forget, if you file a liability or no-fault insurance claim, you've got to spill the beans to Medicare too.
Getting Answers from Medicare
You've got questions? Medicare's got answers! Call 'em up at 800-MEDICARE (800-633-4227, TTY 877-486-2048) or chat with them on Medicare.gov. If you're curious about the Medicare recovery process, reach out to the Benefits Coordination & Recovery Center (BCRC) at 855-798-2627 (TTY 855-797-2627).
Remember, setting up a WCMSA is voluntary, but if you want one, your workers' comp settlement needs to be over $25,000 (or $250,000 if you'll join Medicare within 30 months). And don't even think about using WCMSA funds for anything but the designated purpose — that'd be a no-no, and could lead to claim denials and the need to repay Medicare.
Takeaway: Workers' comp ain't just for federal employees. If you find yourself in this situation, educate yourself on how workers' comp could mess with your Medicare coverage, and always report relevant settlements to Medicare to avoid future claim rejections and reimbursement obligations.
Need more resources to help you navigate medical insurance? Check out our Medicare hub for guidance!
- The Centers for Medicare & Medicaid Services (CMS) may require a Medicare set-aside arrangement (WCMSA) for injury-related medical bills if you receive a workers' compensation settlement, especially if the amount is over $25,000 or $250,000 within the next 30 months.
- If you have workers' compensation benefits and are already on Medicare or will be within 30 months, or if you have a settlement of $25,000 or more and are expected to join Medicare within that timeframe, it's essential to report these details to the Centers for Medicare & Medicaid Services (CMS).
- To ensure your workers' comp settlement doesn't interfere with your Medicare beneficiaries' access to health-and-wellness services, therapies-and-treatments, and healthsystems, follow the guidelines provided by the Centers for Medicare & Medicaid Services (CMS) and be vigilant when navigating the Medicare program.
