Medicare and workers' compensation claims: Important facts to consider

Medicare and workers' compensation claims: Important facts to consider

Workin' with workers' comp as a Medicare beneficiary? Here's the lowdown to stay ahead of potential pitfalls and keep your medical bills under control.

Got a workers' compensation arrangement in the pipeline? Familiarize yourself with it quick, or you'll be coughin' up cash for medical bills down the line. Without informin' Medicare, you risk claim denials and having to reimburse the ol' government health program.

So, what's the skinny on workers' comp? It's insurance for injuries or illnesses that happen directly on the job. federal employees, their families, and certain other entities fall under the Office of Workers' Compensation Programs (OWCP) at the Department of Labor.

Now, it's essential to know how your workers' compensation benefits might impact Medicare's coverage of your medical bills for job-related injuries or sicknesses. Your wallet gonna thank you later.

Workers' Comp Settlement Impact on Medicare

Under Medicare's secondary payer policy, workers' comp's gotta be the main (or primary) man for any treatment related to a work-related injury or illness. If you gotta get an initial check-up before your workers' comp settlement comes through, Medicare may chip in first, then begin a recovery process managed by the Benefits Coordination & Recovery Center (BCRC).

Medicare generally aims to keep an eye on the amount you receive from workers' comp for medical care related to your injuries or illnesses. In some cases, Medicare might request the establishment of a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds. Medicare doesn't cover 'em bills until the WCMSA funds run dry.

Speakin' of WCMSAs, here are the sett'ments you gotta report to Medicare:

1. If you're already in Medicare, or on the cusp, and your settlement is $25,000 or more, send those numbers to CMS.
2. If you ain't in Medicare yet but will be within 30 months of the settlement date, and the settlement is $250,000 or more, get that TPOC to CMS.

Also, don't forget to report if you file any liability or no-fault insurance claims as well.

Got questions about Medicare's recovery process? Contact the BCRC at 855-798-2627 (TTY 855-797-2627). Need general Medicare info? Hit up 800-MEDICARE (800-633-4227, TTY 877-486-2048). During certain hours, you can find a live chat on Medicare.gov.

Faq

1. "Is a Medicare set-aside arrangement mandatory?" - Nope. It's voluntary, but if you wanna set one up, your workers' comp settlement should be over $25,000 or $250,000 if you'll be signing up for Medicare within 30 months.
2. "What happens if I misuse funds from a Medicare set-aside arrangement?" - Don't do it. Making any other use of your WCMSA funds can lead to rejected claims and the need to reimburse Medicare.
3. "Learn more: What to know about Medicare set-aside arrangements."

The Bottom Line

Stay clued up on workers' compensation for federal employees and others. Education is key to avoidin' issues with medical bills for job-related injuries or sicknesses and to keep Medicare on your side.

Most importantly, inform Medicare 'bout your workers' comp arrangements to steer clear of claim denials and having to pay back the man.

Resources for the Win

To help navigate the complex world of medical insurance, visit our Medicare hub.

1. As a Medicare beneficiary, be mindful of your workers' compensation arrangement to avoid unexpected medical expenses from work-related injuries or illnesses.
2. If you're not already in Medicare but will be within 30 months of the settlement date, report a workers' compensation settlement of $250,000 or more to CMS.
3. Medicare's secondary payer policy mandates that workers' compensation must be the primary payer for medical bills related to work-related injuries or illnesses.
4. For settlements under $250,000, if you're already in Medicare or will be within 30 months, inform CMS if the settlement is $25,000 or more.
5. The Benefits Coordination & Recovery Center (BCRC) manages Medicare's recovery process for potential workers' compensation claims in collaboration with CMS.
6. Keep in mind the potential need for a workers' compensation Medicare set-aside arrangement (WCMSA) to prevent overlap in coverage and ensure proper payment for medical bills related to work-related injuries or illnesses.
7. To avoid claim denials and potential reimbursements to Medicare, maintain a healthy workplace-wellness regimen that involves fitness and exercise, therapies and treatments, nutrition, and adherence to the science of health and wellness.

Read also: