Understanding Workers' Compensation and Medicare Interactions: Crucial Information
Workin' comp and Medicare, yo! Here's the deets if you've bagged a workers' comp settlement while on Medicare or about to join the club.
First off, know this: workin' comp needs to pay for any work-related injury treatment ahead of Medicare. But if you've got immediate medical bills and ain't received your workin' comp settlement yet, Medicare might foot the bill first and then go after the recoveries.
To avoid this mess, the folks at Centers for Medicare & Medicaid Services (CMS) like to keep tabs on the workin' comp cash for your work-related medical care. Sometimes, they'll even ask for a special fund called a workers' compensation Medicare set-aside arrangement (WCMSA) for these funds. Medicare only covers your care once all the dough in the WCMSA is used up.
Now, not every workin' comp settlement needs to be reported to Medicare. But if you're already on Medicare or about to join, or if you're Collectin' Social Security Disability Insurance, and the settlement is $25,000 or more, report it! Same goes if you ain't on Medicare yet but will be within 30 months from the settlement date, and the settlement amount is $250,000 or more.
And, if you're filin' a liability or no-fault insurance claim, too, make sure that gets reported as well.
Have any questions? Call 'em up at 800-MEDICARE or use the live chat on Medicare.gov during certain hours. For worries 'bout the Medicare recovery process, hit up the Benefits Coordination & Recovery Center at 855-798-2627.
A Medicare set-aside is voluntary, but if your workin' comp settlement's over $25,000 or $250,000 depending on your Medicare eligibility, consider puttin' one together. And remember, use that WCMSA cash only for the designated purposes or you'll be in deep doo-doo, faced with claim rejections and Medicare reimbursement obligations.
So, remember: keep the workin' comp and Medicare folks in the loop, or you might end up with a whole heap of trouble. For more resources on navigatin' the complex world of medical insurance, check out our Medicare hub. Stay savvy! 😎💺💊💰🗓️
- Workers' compensation Medicare set-aside arrangements (WCMSA) are required when the Centers for Medicare & Medicaid Services (CMS) ask for them to cover work-related medical care.
- A Medicare set-aside is voluntary, but if your work-related injury settlement is over $25,000 or $250,000 depending on your Medicare eligibility, consider creating one to avoid complications.
- Any work-related injury treatment expenses received from workman's compensation will be covered first before Medicare, unless you have immediate medical bills and haven't received your workman's compensation settlement yet.
- If your workers' compensation settlement is $25,000 or more and you are already on Medicare or about to join, or if you're collecting Social Security Disability Insurance, or if the settlement is $250,000 or more and you will be on Medicare within 30 months from the settlement date, be sure to report it.
- In addition to reporting the work-related injury settlement, any liability or no-fault insurance claim should also be reported.
