Medicare and workers' compensation claims: Important facts to understand
Cracking the Code on Workers' Comp and Medicare:
Navigating the intersection of workers' compensation and Medicare is a must for anyone who's banged up on the job. Mystery surrounds this topic, but fear not - we're here to unravel the tangled web.
First off, understand that workers' comp offers a financial lifeline for folks who've gotten hurt or sick because of their job. The folks over at the Office of Workers' Compensation Programs (OWCP) under the Department of Labor are in charge of this benefit, doling it out to federal employees, their families, and some other lucky souls.
Now, if you're currently on Medicare or soon to be eligible, pay attention! How your workers' comp benefits interact with Medicare can make or break your wallet when it comes to medical bills related to your work injury or illness.
Wworkers' Comp Settlements and Medicare: What's the Story?
Under Medicare's rulebook, any treatment for a work-related injury should be covered initially by workers' comp. But if you've got expenses before the workers' comp settlement comes rolling in, Medicare may step up to bat and initiate its recovery game managed by the Benefits Coordination & Recovery Center (BCRC).
To avoid this whole ball of wax, the Centers for Medicare & Medicaid Services (CMS) tends to keep tabs on the amount you receive from workers' comp for your injury or illness-related care. In some instances, Medicare might ask for a workers' comp Medicare set-aside arrangement (WCMSA) for these funds. Medicare won't shell out a dime until every last dollar in your WCMSA has been spent.
So What Needs to Be Reported to Medicare?
It's the responsibility of workers' comp to submit a total payment obligation to the claimant (TPOC) to CMS to ensure Medicare leans in when needed for part of your medical expenses. Here's when you need to ring the alarm bell:
- If you're already on Medicare due to age or Social Security Disability Insurance, and your settlement is $25,000 or more.
- If you're not enrolled in Medicare yet but will within 30 months of the settlement date, and your settlement is $250,000 or more.
In addition to workers' comp, you'll also want to tip off Medicare if you file a liability or no-fault insurance claim.
Frequently Asked Questions
You can quiz Medicare on any question at all: simply dial 800-MEDICARE (800-633-4227) or TTY at 877-486-2048. During certain hours, you can also hit them up via live chat on Medicare.gov! If you've got questions about the Medicare recovery process, you can reach the BCRC at 855-798-2627 (TTY 855-797-2627).
A Medicare set-aside is entirely optional, but if you want to set one up, you'll need a workers' comp settlement of over $25,000 or $250,000 if you're eligible for Medicare within the next 30 months.
Absolutely! Using the money in a Medicare set-aside arrangement for anything other than the designated purpose is a big fat no-no. Ignoring this rule can result in denyed claims and the need to fork over cash to Medicare.
"Like a Boss: Mastering Medicare Set-Asides## In Closing**
Workers' comp is there to help out when you're beaten up on the job, but only if you're aware of how it interacts with Medicare.
If you're already on Medicare or soon to be, it's essential to educate yourself on how workers' comp may impact your coverage to avoid any future headaches with medical bills.
Best of all, report those workers' comp agreements to CMS to avoid claim rejections and unwanted reimbursements.
- Workers' comp benefits, which are crucial for individuals injured or sick due to their job, intersect with Medicare, specifically when it comes to medical expenses related to work injury or illness.
- If a Medicare beneficiary receives a workers' comp settlement of $25,000 or more, it is their responsibility to report this to the Centers for Medicare & Medicaid Services (CMS).
- The Centers for Medicare & Medicaid Services (CMS) keeps track of amounts received from workers' comp for injury or illness-related care and may require a Medicare set-aside arrangement (WCMSA) for these funds.
- The Benefits Coordination & Recovery Center (BCRC) manages Medicare's recovery game if it covers initial treatment for a work-related injury before the workers' comp settlement is received.
