Medicare and Workers' Compensation: Crucial Information You Should Be Aware Of
Unleashing the Nitty-Gritty of Workers' Compensation and Medicare: A Guide
Navigating the intersection of workers' compensation and Medicare can be a minefield, but armed with the right info, you can dodge the landmines. Here's a rundown on how to play it right.
Shedding Light on the Workers' Compensation Maze
Workers' compensation is an insurance safety net for employees suffering work-related injuries or ailments. The Office of Workers' Compensation Programs (OWCP) under the Department of Labor handles this benefit for federal workers, families, and eligible entities.
If you're enrolled in Medicare or will soon be eligible, understanding the interplay of workers' comp and Medicare coverage can help you sidestep issues regarding medical expenses related to work injuries.
Workers' Comp Settlements: How Do They Impact Medicare?
Medicare, as a secondary payer, should be the primary insurer for work-related injury treatment, according to its secondary payer policy. However, if immediate medical expenses outpace the workers' compensation settlement, Medicare may step in and reimburse itself later through the Benefits Coordination & Recovery Center (BCRC).
To avoid a recovery process and preserve funds in a workers' compensation Medicare set-aside arrangement (WCMSA), the Centers for Medicare & Medicaid Services (CMS) may examine the money allotted for work-related injury or illness medical care. In some cases, Medicare might necessitate the implementation of a WCMSA, only covering care after the entire WCMSA fund is depleted.
Which Settlements Require Reporting to Medicare?
Workers' compensation claims must submit a total payment obligation to the claimant (TPOC) to CMS when:
- The individual is already enrolled in Medicare due to age or SSDI eligibility, with settlements amounting to $25,000 or more.
- The person is yet to enroll in Medicare within the next 30 months, provided the settlement is $250,000 or more.
In addition, reporting is necessary for liability or no-fault insurance claims.
Frequently Asked Questions
Got queries? Here are some quick answers:
- Contacting Medicare? Dial 800-MEDICARE (800-633-4227, TTY 877-486-2048), or during certain hours, chat with them online. For questions about the Medicare recovery process, contact the BCRC at 855-798-2627 (TTY 855-797-2627).
- Medicare Set-Asides: Though they're voluntary, if a Medicare beneficiary wishes to set one up, the workers' comp settlement should surpass $25,000 or $250,000 within 30 months if eligible for Medicare.
- Misusing the WCMSA: It is forbidden to misuse the WCMSA for purposes other than the designated one, as doing so may lead to claim denials and having to repay Medicare.
The Bottom Line
Workers' compensation insurance guards federal employees and certain groups against job-related injuries or ailments.
To keep medical expenses in check for retirement-eligible or soon-to-be eligible Medicare individuals, it's essential to grasp how workers' comp might affect their Medicare coverage. Moreover, informing Medicare about workers' comp agreements is crucial to prevent future claim rejections and reimbursement obligations.
Dive Deeper
To help you navigate the intricate world of medical insurance, check out our Medicare hub.
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