Car accidents can be unsettling, leading to physical injuries and financial uncertainties about covering medical costs. Fortunately, Medicare offers a safety net for the over 2 million individuals affected annually, ensuring that most medical expenses are handled.
Even when an automobile liability claim is involved, Medicare often steps in to cover the gaps, providing relief where your auto policy may fall short. Here’s an in-depth look at how Medicare supports you with medical expenses following a car accident.
What Portion of Your Settlement Goes to Medicare?
When you receive a settlement from a personal injury lawsuit, Medicare may claim a portion of these funds if it covers medical expenses related to injuries from a car accident. Legally, Medicare is entitled to reimbursement for what it paid.
The amount Medicare reclaims depends on the settlement size, the medical costs it covers, and whether you have legal representation. Although Medicare can recover its full payment, it may reduce its claim to account for legal fees or if the settlement is less than the actual damages incurred, following federal law guidelines.
The Coverages of Medicare in Florida’s Car Accident
Medicare Part A
Medicare Part A is your go-to for hospital stays, making it less daunting if you are hospitalized from a car accident or other serious conditions. It covers the essentials during your stay—think room and board, meals, nursing care, and other necessary supplies to help you get back on your feet.
- Inpatient Hospitalization: If your car accident injuries are severe enough to require hospital admission, Part A covers them.
- What’s Covered: It focuses on necessary inpatient care, which means the treatment must be crucial for your recovery.
- Keep in Mind: There’s a deductible with Part A, and while it covers many aspects of a hospital stay, it doesn’t pick up everything. Extended stays might also involve co-payments.
Remember, Part A doesn’t cover outpatient services or the ambulance ride to the hospital. For those needs, you’ll look to other parts of Medicare.
Medicare Part B
Medicare Part B complements Part A by covering what happens outside the hospital. It’s all about the care you receive. At the same time, you’re not admitted: doctor visits, X-rays, ambulance transport if you’re not admitted, and even durable medical equipment to aid recovery after an accident.
- Essential Services: It include necessary doctor visits, diagnostic tests to assess your injuries, and any equipment you might need during recovery.
- Medical Necessity is Key: Services under Part B must be considered essential for diagnosing or treating your injuries, ensuring that every treatment or test is tailored to your needs.
What to Remember About Part B:
- Prior Authorization: Some services may need a green light from Medicare first to ensure they are necessary and avoid unnecessary treatments.
Medicare Part A and Part B are vital in managing your healthcare after an accident. They provide a safety net that lets you focus more on recovery and less on red tape.
What Are the Costs of Medical Care After a Car Accident with Medicare?
If you’re a Medicare beneficiary and you’ve been involved in a car accident, the costs associated with your medical treatment can vary significantly based on several factors, including the severity of your injuries, the types of medical services you need, and the specifics of your Medicare plan.
Medicare Part A typically provides coverage for hospital stays and inpatient care related to car accident injuries. However, financial responsibilities such as deductibles and co-payments still apply.
For instance, as of 2023, the deductible for Medicare Part A is set at $1,608 for each benefit period. Additional daily co-payments may kick in for prolonged hospital stays after a certain number of days.
Outpatient services fall under Medicare Part B. For 2023, the annual deductible for Part B is $233.
Once this deductible is met, you generally cover 20% of the costs for Medicare-approved outpatient services as coinsurance.
Ambulance services are also covered under Medicare Part B, usually up to 80% of the Medicare-approved amount. You must pay the remaining 20% plus additional fees, such as mileage or special equipment costs.
These out-of-pocket costs emphasize the importance of understanding your Medicare coverage details and planning for any unforeseen medical expenses following a car accident.
Coverage for Medical Expenses After a Car Accident Under Medicare
Suppose you are a Medicare beneficiary involved in a car accident. In that case, it’s essential to understand the range of medical treatments and services covered under Original Medicare (Part A and Part B) for injuries sustained:
- Therapy Services: Medicare Part B covers outpatient physical and occupational therapy that a doctor deems necessary due to car accident injuries. There are caps on the amount Medicare will cover for therapy services each year, and you are responsible for the Part B deductible and coinsurance.
- Durable Medical Equipment (DME): This includes necessary medical devices such as braces for arms, legs, back, and neck. Coverage is available under Part B, but your suppliers and doctors must be enrolled in Medicare. Some areas might also require adherence to Medicare’s competitive bidding program, limiting supplier options. You are liable for 20% of the Medicare-approved amount after any deductibles.
- Diagnostic Imaging: Outpatient imaging services like post-accident X-rays are covered under Part B, with patients covering 20% of the costs after meeting the deductible.
- Chiropractic Care: Medicare Part B covers chiropractic services to correct spinal subluxation (misalignment). Related services such as massages or acupuncture are not covered. Chiropractic care is covered at 80% after the deductible is met.
- Prescription Medications: Medicare Part A covers medications administered during an inpatient stay. Outpatient medications, including those taken at home or received in an emergency room, typically fall under Medicare Part D, your prescription drug plan. This can include various medicines, from pain relievers to antibiotics. Costs such as deductibles and copayments will depend on your Part D plan.
- Cosmetic Surgery: If required to correct disfigurements from injuries sustained in a car accident, some cosmetic procedures might be covered under Original Medicare, subject to the usual deductibles and coinsurance.
- Mental Health Care: Outpatient mental health services provided by licensed professionals like psychiatrists or psychologists are covered under Part B. This includes therapy sessions and consultations, with patients responsible for the deductible and coinsurance. Additional copayments might apply for services rendered in hospital outpatient settings.
Steps to Take For Insurance Claims When You’re Not At Fault
If you were not at fault in a car accident and have Medicare Part A, take these steps to cover your medical expenses:
- Seek Medical Attention: Immediately after the accident, get medical help to document injuries and start treatment, even if symptoms are not apparent.
- Contact Your Insurance: If you have private health insurance, inform your provider about the accident and submit the necessary documentation for coverage.
- File a Personal Injury Claim: Consider legal action against the at-fault driver’s insurer for compensation for medical costs, lost wages, and other damages. Consult a personal injury attorney to explore your options.
- Coordinate with Your Healthcare Provider: Discuss treatment plans that align with your coverage limits.
- Keep Detailed Records: To support your compensation claim, maintain records of all medical care, expenses, and interactions with insurers and legal representatives.
Understanding Exemptions for Pain and Suffering in Settlements
Medicare does not have the authority to claim any part of the damages awarded for pain and suffering within a settlement. Such compensation must be explicitly designated as for pain and suffering by the court, not merely outlined by your attorney.
Consider a hypothetical settlement of $250,000, where $200,000 is attributed to pain and suffering. In this case, Medicare can only place a lien on the $50,000 intended for medical expenses.
This allows you to retain the full $200,000 awarded for your pain and suffering.
Guiding these settlements can be intricate, and disputes over Medicare repayments are common. Therefore, it is advisable to consult with an attorney from the CEO Lawyer Personal Injury Law Firm.
Our team is prepared to handle negotiations with Medicare to ensure you receive the maximum possible portion of your settlement.
Why Engage a Personal Injury Lawyer When You Have Medicare in Florida?
Filing a claim against the at-fault driver’s insurance can ensure that the responsibility for your medical expenses falls on the insurer rather than you, even after Medicare or Medicaid has covered initial costs.
The complexities of insurance claims and healthcare bureaucracy can be overwhelming due to stringent deadlines and extensive paperwork. Furthermore, Medicare and Medicaid typically require reimbursement from any settlement you receive.
A Florida car accident lawyer can clarify your options and help maximize your settlement. If you’ve been involved in a serious car accident in Florida and are covered by Medicaid or Medicare, consider consulting with the CEO Lawyer Personal Injury Law Firm.
We provide free consultations to discuss your rights and determine the best action.
For a free consultation with one of our skilled attorneys, please call us at (864) 664-3865 or complete our online contact form today.
