Medicare and Workers' Compensation Interactions: Essential Facts to Understand
My Toxic, Uncensored Guide to Workers' Compensation and Medicare
Listen up, buddy! Here's your lowdown on workers' comp and Medicare.
Workers' compensation is insurance that covers federal employees and a few other dudes if they get injured or sick on the job. The Office of Workers' Compensation Programs (OWCP) under the Department of Labor doles out this sweet deal.
Now, if you're currently rocking Medicare or about to, you've gotta know how your workers' comp settlement could affect the medical coverage for those workplace woes. It's crucial for avoiding headaches with medical bills.
So, how does a workers' comp settlement affect Medicare?
Under Medicare's secondary payer policy, workers' comp is the boss man for any treatment related to a work injury. But if medical expenses pop up before you score that comp settlement, Medicare steps in. Then, the Benefits Coordination & Recovery Center (BCRC) gets involved and starts reclaiming the dough it coughs up.
To avoid such drama, the Centers for Medicare & Medicaid Services (CMS) likes to keep tabs on the amount you rake in from workers' comp for injury- or illness-related medical care. In some cases, Medicare might request a workers' comp Medicare set-aside arrangement (WCMSA). Once the WCMSA fund is emptied, Medicare will cover the care.
Which settlements need reporting to Medicare?
Workers' comp has to share the total payment obligation to the claimant (TPOC) with CMS. The TPOC includes the total amount that comp owes you or on your behalf.
If you're already on Medicare (either due to age or SSDI) and the settlement is at least $25,000, you gotta report it to CMS. Or, if you're not currently on Medicare, but you'll qualify within 30 months of the settlement date, and the settlement amount is $250,000 or more, time to spill the beans to Medicare.
Oh, and by the way, if you file a liability or no-fault insurance claim, that needs reporting too.
Questions you're itching to ask
Curious about something Medicare-related? Give them a ring at 800-MEDICARE (800-633-4227). During certain hours, live chat is also available on Medicare.gov. If you've got questions about Medicare recovery process, hit up the BCRC at 855-798-2627.
A Medicare set-aside is volunteer, but if you wanna set one up, your comp settlement has to be over $25,000, or over $250,000 if you'll be Medicare eligible within 30 months.
Dude, it's forbidden to use the WCMSA dough for anything other than what it's intended for. Ignoring this can result in claim denials and reimbursement obligations.
The bottom line
Workers' compensation is for job-related injuries or illnesses for federal employees and a few others.
If you're on Medicare or about to be, educate yourself on how workers' comp may affect your coverage to avoid issues with medical expenses.
Remember, informing Medicare about workers' comp agreements is crucial to avoid claim rejections and reimbursement obligations.
Medicare resources
Need more guidance on navigating the complex world of medical insurance? Hit up our Medicare hub!
- If your workers' comp settlement is over $25,000 and you're already on Medicare, or if it's over $250,000 and you'll be Medicare eligible within 30 months, you're required to report it to Medicare.
- The Centers for Medicare & Medicaid Services (CMS) might ask for a workers' comp Medicare set-aside arrangement (WCMSA) depending on the amount you receive from workers' comp for injury- or illness-related medical care.
- It's essential to use WCMSA funds only for what they're intended for, as ignoring this rule can lead to claim denials and reimbursement obligations.
- The Benefits Coordination & Recovery Center (BCRC) gets involved when Medicare covers medical expenses before a workers' comp settlement, and they start reclaiming the money they expend.
