Navigating Workers' Compensation and Medicare: Key Insights to Consider
Understanding the Importance of Notifying Medicare about Workers' Compensation Settlements
Workers' compensation provides financial aid to employees who suffer job-related injuries or illnesses, overseen by the Office of Workers' Compensation Programs (OWCP) under the Department of Labor. This benefit applies to federal employees, their families, and certain other entities.
It's crucial for individuals enrolled in Medicare or soon to be eligible to grasp how their workers' compensation benefits may impact Medicare's coverage of medical claims associated with work-related injuries. Proactive understanding of these matters can help prevent complications related to medical costs.
When it comes to workers' comp settlements and Medicare coverage, Medicare follows the "secondary payer" policy. This means that workers' compensation must cover any treatment for work-related injuries before Medicare steps in. In case of immediate medical expenses prior to the receipt of workers' compensation settlements, Medicare may pay first, initiating a recovery process managed by the Benefits Coordination & Recovery Center (BCRC).
To avoid a recovery process and potential complications, the Centers for Medicare & Medicaid Services (CMS) tends to monitor the amount a person receives from workers' compensation for injury or illness-related medical care. In some situations, Medicare may require a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) for these funds, covering care only after the WCMSA has been depleted.
Workers' compensation settlements that exceed certain thresholds must be reported to Medicare. Settlement thresholds include $25,000 for individuals already enrolled in Medicare based on age or Social Security Disability Insurance, or $250,000 if the person will qualify for Medicare within 30 months of the settlement date. Additionally, reporting is necessary if the person files a liability or no-fault insurance claim.
For more resources to help navigate the intricacies of medical insurance, visit the Medicare hub. For questions about workers' compensation and Medicare, contact Medicare at 800-MEDICARE, or via live chat on Medicare.gov during certain hours. For queries about the Medicare recovery process, contact the BCRC at 855-798-2627 (TTY 855-797-2627).
Avoid rejections, complications, and reimbursement obligations by ensuring proper notification of workers' compensation agreements to Medicare. For detailed instructions and up-to-date information about reporting, refer to the CMS NGHP User Guide and the Section 111 COBSW website.
- Individuals receiving workers' compensation for job-related injuries should be aware of how this may impact their Medicare coverage, as Medicare follows the "secondary payer" policy.
- Medicare may require a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) for funds received from workers' compensation settlements, to cover care only after the WCMSA has been depleted.
- Workers' compensation settlements that exceed certain thresholds must be reported to Medicare, with the thresholds being $25,000 for those already enrolled in Medicare or $250,000 for those who will qualify within 30 months.
- To effectively navigate the complexities of medical insurance and workers' compensation, residents can seek resources from the Medicare hub, contact Medicare, BCRC, or visit the CMS NGHP User Guide and the Section 111 COBSW website for detailed instructions and up-to-date information.
