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Will Medicare Will Pay Your Accident Related Medical Expenses?

Guy DiMartino Jan. 23, 2015

The baby boomers are reaching retirement age and with retirement comes Medicare. A question that people injured in accidents have is will Medicare pay my accident related expenses?

The simple answer is yes. This is how it works. If you're injured in an accident, the first line of insurance would be first party medical payments. Many car insurance policies have med-pay. Medical payments limits are usually $1000 to $10,000. Also, a lot of commercial general liability and homeowner's policies have med-pay. If you are injured on a person's or business' property and there is med-pay available, it will pay your accident related expenses regardless of fault.

If you are a Medicare beneficiary and your med-pay benefits have reached its limit, your health care providers should bill Medicare. Healthcare providers are not real thrilled about having to bill Medicare because they will be paid the Medicare fee schedule, which is substantially lower than the provider's regular fees.

If Medicare pays injury related expenses, the payments are “ conditional payments”, which are covered under the Medicare Secondary Payer Act. At the end of your case, Medicare will have a right of reimbursement. The same is true with health insurance and med-pay insurance. Medicare's right of reimbursement is not dollar for dollar. So if you have a lawyer representing you in your accident claim- Medicare will pay a pro-rata share of the attorney's fees and costs.

Some injured people don't want to go through the hassle of dealing with Medicare but in the long run, it is best that Medicare handle your expenses for a number of reasons.

Every year the Medicare secondary payer law gets more and more complex. Please don't put yourself in a position to settle a case on your own when Medicare has made some payments because you could lose your Medicare benefits in the future.