Workers' Compensation and Medicare: Essential Facts to Understand
Navigating Medicare and workers' compensation can be tricky, but understanding the ins and outs is crucial to avoid unnecessary costs and hassles.
For starters, workers' compensation is insurance for those who get injured or sick on the job. The Office of Workers' Compensation Programs (OWCP) turns to the Department of Labor when it comes to doling out this benefit for federal employees, their families, and specific other entities.
As someone enrolled in Medicare or soon to be, it's essential to grasp how workers' compensation might impact Medicare's coverage of your medical bills. This know-how prevents problems with medical expenses stemming from workplace injuries or illnesses.
So, how does a workers' comp settlement affect Medicare?
Under Medicare's secondary payer policy, workers' compensation must pay for injury-related treatments before Medicare steps in. In cases where immediate medical expenses stem from a work-related injury before you get your workers' compensation settlement, Medicare might cover first and start a recovery process managed by the Benefits Coordination & Recovery Center (BCRC).
To avoid a recovery process, it's advisable to let the Centers for Medicare & Medicaid Services (CMS) monitor the amount you receive from workers' compensation for your injury- or illness-related medical care. In some instances, Medicare may ask for the establishment of a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds. Medicare will only pay for your care after exhausting the funds in the WCMSA.
Need to report a settlement to Medicare? Here's what's required:
-When a person already enrolled in Medicare based on age or receiving Social Security Disability Insurance receives a settlement of $25,000 or more, workers' compensation must submit a total payment obligation to the claimant (TPOC) to CMS.
-If the person is not currently enrolled in Medicare but will qualify for the program within 30 months of the settlement date, and the settlement amount is $250,000 or more, a TPOC is also necessary.
-It's not just workers' comp. You'll have to report to Medicare if you file a liability or no-fault insurance claim too.
Sales Pitch
Navigating the complexities of Medicare and workers' compensation can be overwhelming. To make things easier, we offer resources to guide you through the intricate world of medical insurance. Visit our Medicare hub for more information.
Remember, knowledge is power, so take control of your health and financial future by learning the ins and outs of Medicare and workers' compensation.
- It's important to understand that workers' compensation funds are expected to cover injury-related treatments before Medicare steps in, as per Medicare's secondary payer policy.
- When a Medicare beneficiary receives a workers' compensation settlement of $25,000 or more, it's necessary to submit a total payment obligation to the claimant (TPOC) to Medicare.
- If a person will qualify for Medicare within 30 months of the settlement date and the settlement amount is $250,000 or more, a TPOC is also required.
