Medicare and Workers' Compensation Interplay: Crucial Information
Having Trouble Navigating Workers' Comp and Medicare? Here's a Straighforward Guide
Navigating workers' compensation when you're on Medicare can be a headache. Missteps can lead to claim denials and owing Medicare money. Here's what you need to know.
Workers' compensation is insurance for employees who suffer job-related injuries or illnesses. The Office of Workers' Compensation Programs (OWCP) oversees this benefit for federal employees, their families, and certain other entities.
Table it like this: If you're on Medicare or about to be, it's crucial to understand how workers' compensation might affect your medical bills for work-related injuries. Otherwise, you could end up with some nasty medical bills.
Workers' Comp Settlements and Medicare
Under Medicare's rules, workers' compensation should pay for any treatment related to a work injury. But what happens if you have expenses before you get your workers' comp settlement? In that case, Medicare might cover your costs temporarily and ask for reimbursement later.
Centers for Medicare & Medicaid Services (CMS) wants to have a good idea of the money you get from workers' comp for your injury-related medical care. They might even create a workers' comp Medicare set-aside arrangement (WCMSA) for these funds. CMS won't cover your care until the money in the WCMSA is all gone.
What Needs to be Reported to Medicare
When you get a workers' comp payment totaling $25,000 or more, you must tell CMS about it if you're already on Medicare or will be soon. If you're not on Medicare but will be within 30 months of the settlement date and your settlement is $250,000 or more, you also need to report it.
Keep in mind that you also need to report liability or no-fault insurance claims to Medicare.
Frequently Asked Questions
Don't hesitate to reach out to Medicare if you have any questions. You can call them at 800-MEDICARE (800-633-4227) or chat with them on Medicare.gov during certain hours. If you have questions about the Medicare recovery process, give the Benefits Coordination & Recovery Center (BCRC) a ring at 855-798-2627.
A WCMSA is voluntary, but if you want to set one up and your settlement is over $25,000 (or $250,000 within 30 months if you'll be on Medicare), you gotta do it. And remember: it's illegal to use the money in a WCMSA for anything other than its intended purpose. Misuse can lead to claim denials and owing Medicare money.
Learn More: Want to learn more about Medicare set-asides? Check out our Medicare hub for more resources.
Final Takeaway
Workers' compensation is designed for job-related injuries or illnesses. If you're on Medicare or soon will be, educate yourself about how workers' comp might impact your medical bills to avoid complications. And remember, it's essential to tell Medicare about your workers' comp arrangement to avoid future claim rejections and repayment obligations.
- In the realm of health-and-wellness and workers' compensation, it's crucial to understand that Medicare should pay for any treatment related to a work injury. However, if you have expenses before receiving your workers' comp settlement, Medicare might cover you temporarily and request reimbursement later.
- When you receive a workers' comp payment totalling $25,000 or more while on Medicare or within 30 months of the settlement date, you're required to inform Centers for Medicare & Medicaid Services (CMS) about it. Similarly, if you're not on Medicare but will be within 30 months and your settlement is $250,000 or more, you also need to report it.
- Medicare's Centers for Medicare & Medicaid Services often create a workers' comp Medicare set-aside arrangement (WCMSA) for funds related to injury-related medical care. CMS will not cover your care until the money in the WCMSA is exhausted.
- It's important to remember that workers' compensation therapy-and-treatments and nutrition services might also be affected by your Medicare status, and failure to report these arrangements could lead to claim denials and repayment obligations to Medicare.
