Medicare and your Virginia Car Accident Case.

If you’ve been involved in a Virginia car accident and are covered by Medicare, certain issues can arise that aren’t the same as if you have a private health insurance company.  With that said, if you’re fortunate enough to have health insurance, including Medicare, you should make sure to take advantage of it if and when possible.

Does Medicare cover treatment for my Virginia car accident case?

If you have Medicare, typically Medicare will cover at least some part of the medical bills incurred for your car accident claim.  At least here in Virginia, exactly how much Medicare will pay will depend on what other source of insurance you have and the type of Medicare coverage to which you subscribe. 

Medicare is a Secondary Payer.

First, Medicare is a “Secondary Payer.”  What this means in plain language is that Medicare only coverers payments after you exhausted other types of coverage.  In Virginia, this typically means after you exhausted all Medical Expense Coverage (or “MedPay”) under your car insurance.  (To determine if you have Medpay, you should look at your car insurance declarations page to see if you purchased it.  Here’s a video on how to read your declarations page. When most folks purchase Medpay, they’ve typically purchased a small amount – $3,000 to $5,000.  However, we’ve seen policies as high as $100,000). 

Different types of Medicare Coverage.

Assuming that Medicare is indeed next in line to pay your medical bills, what it pays will depend on your coverage.  While below is just a summary, click here to learn more about Medicare directly from Medicare’s official government website here.

  • Medicare Part A (Hospital Insurance): helps cover inpatient care in hospitals, skilled nursing care, hospice care and some home health care.
  • Medicare Part B (Medical Insurance): helps cover services from doctors and other providers, outpatient care, home health care, durable medical equipment (wheelchairs, walkers, etc.).
  • Medicare Part D (Drug Coverage): helps cover cost of prescription drugs.
  • Medicare Advantage (aka Part C): Medicare-approved plan from private company that offers alternatives for drug coverage and is typically “bundled” with Part A, B and D.
  • Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private insurance company to help pay your share of costs for your Medicare coverage.

What happens after I get out of the hospital?

While in hospital care is typically the most straight forward for Medicare to cover, after leaving the hospital things can get a bit complicated.  Indeed, home health care often causes confusion.  Therefore, Medicare authored a blog to discuss this in greater detail, which you can read here.

Take some time to read this blog in detail.  However, Medicare typically will not cover: 24 hour day care at your home, meals delivered to your home, shopping/cleaning, custodial or personal care. 

Remember, Medicare will have a lien on your car accident claim.

If you’re lucky enough to have Medicare cover most or all of your bills, that’s a good thing.  Once your car accident case is ready to pursue, you’ll then be able to claim the retail price of your medical treatment in your car accident case.  However, remember Medicare will have a lien on any proceeds you receive in your car crash case. (Click here to learn more about health insurance liens)

With that said, assuming there’s enough car accident insurance funds, the benefit is having to reimburse Medicare is that they typically pay your providers at a significantly reduced rate than if you were to pay out of pocket.  What’s more, they also typically pay at a lower rate than a private health insurer.  Therefore, your health insurance lien will likely be less than any other health insurance reimbursement.

However, Medicare may also have rights to future proceeds after your settlement if you require future treatment related to your car accident claim.

Of course, this is just for informational purposes.

Medicare coverage is very complicated.  And this article is simply meant to give you a starting off point.  Should you have been involved in a Virginia car accident case, and you have Medicare coverage, make sure that your medical providers submit your bills to Medicare.  And make sure that you follow up with both your providers and Medicare to make sure the bills are being covered.  Sometimes issues come up that you wouldn’t expect, and it’s important that you not simply rely on other folks looking out for your best interests.

Still have questions?

Make sure to check out our Personal Injury & Criminal Defense Practice Pages where we’ve answered many other questions you likely have.  James Abrenio is a Fairfax-Based Personal Injury & Criminal Defense attorney who practices throughout Northern Virginia. You can learn more about James Abrenio, some of our Prior Results, and Read Our Reviews.  Make sure to contact us at Ph. 703-570-4180 for your Free Consultation.