Understanding the Intersection of Workers' Compensation and Medicare: Crucial Information
Rewritten Article:
Navigating Medicare's waters when it comes to workers' comp is crucial. Neglecting to notify Medicare about a workers' compensation arrangement could lead to claim denials and the need to repay Medicare.
Workers' compensation serves as insurance for folks who've suffered job-related injuries or illnesses. This benefit is managed by the Office of Workers' Compensation Programs (OWCP), which falls under the Department of Labor, and applies to federal employees, their families, and certain other entities.
If you're enrolled in Medicare or about to join, it's vital to understand how your workers' compensation benefits could affect Medicare's coverage of your medical claims, helping you avoid complications with medical costs resulting from work-related injuries.
What's the Deal with Workers' Comp Settlements and Medicare?
Medicare operates under a secondary payer policy, meaning workers' compensation must shell out for any treatment related to a work-related injury before Medicare chips in.
In situations where immediate medical expenses pop up before the recipient receives their workers' compensation settlement, Medicare might cover the initial costs and initiate a recovery process managed by the Benefits Coordination & Recovery Center (BCRC). To avoid a recovery process, the Centers for Medicare & Medicaid Services (CMS) prefers to monitor the funds received by the person for their injury or illness-related medical care.
In some cases, Medicare may ask for the establishment of a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds. Medicare will only cover the care once the WCMSA funds run out.
Which Settlements Must be Reported to Medicare?
Workers' compensation must submit a payment total to CMS to ensure Medicare takes care of the appropriate portion of a person's medical expenses. This represents the total amount owed to the person or on their behalf.
Reporting is essential if a person is currently enrolled in Medicare based on their age or SSDI, and the settlement is $25,000 or more. TPOCs are also necessary if the person is not yet enrolled in Medicare but will qualify within 30 months of the settlement date, and the settlement amount is $250,000 or more. In addition to workers' comp, a person must report to Medicare if they file a liability or no-fault insurance claim.
FAQs
- You can contact Medicare with any question by dialing 800-MEDICARE (800-633-4227, TTY 877-486-2048). During certain hours, live chat is also available on Medicare.gov.
- If you have questions about the Medicare recovery process, you can contact the BCRC at 855-798-2627 (TTY 855-797-2627).
- Yes, it's prohibited to use the money in a Medicare set-aside arrangement, such as a WCMSA, for any purpose other than the intended one, as misusing the funds could lead to claim denials and the need to repay Medicare.
Takeaway
Workers' compensation is insurance for job-related injuries or illnesses for federal employees and certain other groups.
It's essential that those enrolled in Medicare or soon to be eligible educate themselves on how workers' compensation may impact their Medicare coverage to avoid issues with medical expenses.
Proactively informing Medicare about workers' compensation arrangements can prevent future claim rejections and repayment obligations.
Resources for Medicare
For more guidance on navigating the complex world of medical insurance, visit our Medicare hub.
- Medicare Set-aside arrangements (WCMSAs) may be established for cases where a workers' compensation settlement is involved, ensuring Medicare only covers care once WCMSA funds are exhausted.
- When a workers' compensation settlement is $25,000 or more for individuals currently enrolled in Medicare or qualified via SSDI, or $250,000 or more for those not yet enrolled but will be within 30 months, reporting is essential to Medicare.
- The unauthorized use of funds in a Medicare set-aside arrangement (WCMSA) for purposes other than intended therapy, treatments, or nutrition can result in claim denials and the need to repay Medicare.
- To understand how workers' compensation might affect Medicare's coverage for health-and-wellness and therapies-and-treatments related to work-related injuries, it's important to educate oneself if enrolled in Medicare or soon to be eligible.
