Navigating Interplay between Workers' Compensation and Medicare: Crucial Facts Explained
Navigating workers' comp and Medicare ain't no walk in the park, especially when it comes to workers' compensation insurance for job-related injuries or illnesses for federal employees and certain groups. For folks enrolled in Medicare or about to join, knowing how comp affects your Medicare coverage can save you some headaches down the road.
First things first: reporting your workers' comp agreement to Medicare is crucial to steer clear of claim rejections and reimbursement hassles later on. Here's what you gotta know:
Workers' Comp Settlements and Medicare: A Breakdown
Under Medicare's secondary payer policy, workers' comp needs to cover any work-related injury treatments before Medicare steps in. If medical expenses pop up before you get your comp settlement, Medicare might dish out the dough first and kick off a recovery process managed by the Benefits Coordination & Recovery Center (BCRC). To avoid all that, the Centers for Medicare & Medicaid Services (CMS) keep an eye on the amount you get from workers' comp for your injury-related medical care.
In some instances, Medicare might request a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds, where they'll only cover the care after the WCMSA funds run out.
So, which comp settlements need to be reported to Medicare? When your settlement reaches $25,000, or $250,000 if you'll qualify for Medicare within 30 months of the settlement date, it's time to notify Medicare.
Common Questions about Reporting Workers' Comp Settlements to Medicare
If you've got questions, Medicare has answers. Call 'em at 800-MEDICARE, or during specific hours, chat online on Medicare.gov. If you're curious about the Medicare recovery process, hit up the BCRC at 855-798-2627.
A WCMSA is optional, but if you want to set one up and your comp settlement is over $25,000, or $250,000 if you're gonna qualify for Medicare within 30 months, it's obligatory. FYI, misusing the WCMSA funds can lead to claim denials and reimbursement obligations.
Remember: alerting Medicare about your workers' comp agreement is vital to avoid any future claim rejections and reimbursement obligations.
Medicare resources
For more ins and out of medical insurance, head over to our Medicare hub to cruise through the complex world like a pro!
- Under Medicare's secondary payer policy, workers' comp is responsible for covering any work-related injury treatments before Medicare steps in.
- If your workers' comp settlement for injury-related medical care exceeds $25,000, or $250,000 if you will qualify for Medicare within 30 months of the settlement date, it's mandatory to report the settlement to Medicare.
- Medicare may request a workers' compensation Medicare set-aside arrangement (WCMSA) for funds over $25,000, which will only cover care after the WCMSA funds have been exhausted.
- In the process of reporting workers' comp settlements, resources such as Medicare's helpline (800-MEDICARE) and the Benefits Coordination & Recovery Center (BCRC, 855-798-2627) are available with answers to any questions you might have.
