Medicare and Workers' Compensation: Important Information
Rewritten Article:
Navigating the maze of Medicare and workers' compensation is a must. Neglecting to inform Medicare about a workers' comp arrangement could lead to claim denials and the need to repay Medicare.
Workers' compensation serves as insurance coverage for employees who suffer job-related injuries or illnesses. The Office of Workers' Compensation Programs (OWCP) under the Department of Labor manages this benefit, which applies to federal employees, their families, and other specific groups.
Individuals enrolled in Medicare or soon to become eligible should understand how workers' comp can influence Medicare's coverage of their medical claims. This understanding helps avoid complications involving medical costs related to work injuries or illnesses.
How does a workers' comp settlement impact Medicare?
Under Medicare's secondary payer policy, workers' comp should cover any treatment related to a work injury before Medicare steps in. If immediate expenses pop up before the person receives their workers' comp settlement, Medicare might pay first and then initiate a recovery process managed by the Benefits Coordination & Recovery Center (BCRC). To avoid such procedures, it's best to keep the Centers for Medicare & Medicaid Services (CMS) abreast of the amount a person receives for their injury- or illness-related medical care from workers' comp.
In certain cases, Medicare might request a workers' compensation Medicare set-aside arrangement (WCMSA). Medicare will only cover treatment after the WCMSA funds have been exhausted.
What settlements need to be reported to Medicare?
It's crucial for workers' comp to submit a total payment obligation to the claimant (TPOC) to CMS. This represents the total amount workers' comp owes to the person or on their behalf.
It's necessary to submit a TPOC if a person is already enrolled in Medicare due to age or Social Security Disability Insurance, and the settlement is $25,000 or more. TPOCs are also crucial 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.
A person must also report to Medicare if they file a liability or no-fault insurance claim.
Frequently Asked Questions
To reach out to Medicare with questions, call 800-MEDICARE (800-633-4227, TTY 877-486-2048). During specific hours, live chat is available on Medicare.gov. For questions about the Medicare recovery process, contact the BCRC at 855-798-2627 (TTY 855-797-2627).
A Medicare set-aside is voluntary. However, if a Medicare beneficiary wants to set one up, their workers' comp settlement must be over $25,000. Alternatively, it must be over $250,000 if they are eligible for Medicare within 30 months.
It's prohibited to use funds meant for a Medicare set-aside arrangement like a WCMSA for any purpose other than its intended use. Mismanaging these funds could lead to claim denials and the need to reimburse Medicare.
Learn more: What you need to know about Medicare set-asides
Takeaway
Workers' compensation serves as insurance for job-related injuries or illnesses for federal employees and specific groups.
For those enrolled in Medicare or soon to be eligible, it's essential to educate oneself on how workers' compensation may impact their Medicare coverage to avoid issues with medical expenses.
Properly informing Medicare about workers' comp agreements is crucial to avoid future claim rejections and reimbursement obligations.
Medicare Resources
For more resources to help navigate the complex world of medical insurance, visit our Medicare hub.
- To avoid claim denials and reimbursement obligations, it's crucial to keep the Centers for Medicare & Medicaid Services (CMS) informed about the total amount received for injury- or illness-related medical care from workers' compensation.
2.Workers' compensation should cover any treatment related to a work injury before Medicare steps in, but in certain cases, Medicare might request a workers' compensation Medicare set-aside arrangement (WCMSA) to cover treatment after the WCMSA funds have been exhausted.
- It's necessary to submit a total payment obligation to the claimant (TPOC) to CMS if a person is already enrolled in Medicare due to age or Social Security Disability Insurance, and the settlement is $25,000 or more, or 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.
- Mismanaging funds meant for a Medicare set-aside arrangement like a WCMSA could lead to claim denials and the need to reimburse Medicare, making it essential to use these funds only for their intended purpose.
