Does Medicare Cover Car Accident Injuries?

Medicare is a federal health insurance program that provides coverage for individuals aged 65 or older, as well as certain younger individuals with disabilities. Understanding whether Medicare covers injuries sustained in car accidents is crucial for beneficiaries, particularly in Nebraska where auto insurance laws and healthcare systems may impact how claims are processed. However, in a nutshell, Medicare does cover treatment of car accident injuries, and injured victims want ALL medical expenses to be submitted to, and processed by, Medicare when they have sustained injuries due to someone else’s negligence.

This article provides a brief overview of Medicare coverage for car accident-related injuries, emphasizing its limitations, exceptions, and the steps beneficiaries should take. Medicare conditional payments, and subrogation in general, can be extremely complex, but the below at least provides an idea of Medicare’s involvement when someone has sustained injuries from a crash.

If you’ve been injured from a car accident and are interested in legal counsel, visit our Personal Injury Law page for more information.  Otherwise, you can also visit the Centers for Medicare and Medicaid Services website for information on Medicare’s recovery process for payments made concerning injury claims.

Parts of Medicare Coverage

Medicare is divided into different parts:

• Part A: Hospital insurance, covering inpatient care, skilled nursing facilities, and hospice.
• Part B: Medical insurance, covering outpatient services, doctor visits, and preventive care.
• Part C (Medicare Advantage): Private plans offering comprehensive coverage, often including vision, dental, and prescription drugs.
• Part D: Prescription drug coverage.

Each part plays a role in addressing healthcare needs, but understanding how these parts apply to car accident-related injuries is critical.

Car Accident-Related Injuries & Medicare

Medicare covers injuries from car accidents, but the type of coverage depends on the nature of the care required:

1. Emergency Services: Medicare Part B typically covers ambulance transportation and emergency room visits if medically necessary.
2. Hospital Stays: If the injuries require hospitalization, Medicare Part A will cover inpatient care, subject to deductibles and coinsurance.
3. Follow-Up Care: Physical therapy, rehabilitation, and outpatient follow-up appointments are covered under Part B.
4. Prescription Medications: If prescribed medications are needed post-accident, they may be covered under Part D or through a Medicare Advantage plan.

Coordination of Benefits in Nebraska

Nebraska operates under a fault-based auto insurance system, which means the at-fault driver’s insurance is typically responsible for covering damages, including medical expenses. Medicare is considered a secondary payer in such situations; however, Medicare will process and pay medical expenses following a crash so long as Medicare is provided with the relevant claim information. Further, Medicare directs all healthcare treatment providers to submit all medical expenses for processing within one year of the crash. If the car accident involves an at-fault party, Medicare will initially pay medical expenses but will seek reimbursement once there has been recovery on the claim, referred to as subrogation.

These payments by Medicare are referred to as conditional payments: Medicare will make payments conditionally but requires repayment once the beneficiary receives a settlement or judgment from the at-fault party. There are a number of reasons it’s important for treatment providers to submit bills to Medicare following a car accident, but two of the most important are (1) submission of bills to Medicare ensures timely payment – insurance injury claims often last months, if not years.  Processing of medical bills by Medicare ensures the bills get paid no matter what, and the injured victim avoids collections; and (2) payment of bills by Medicare results in greater recovery – Medicare has large contractual adjustments with healthcare providers. Processing of medical bills by Medicare will result in more of any settlement funds, or award at trial, going directly to the injured victim rather than to past medical treatment providers.

Steps to File a Claim

To ensure coverage for accident-related injuries, beneficiaries in Nebraska should make clear to all treatment providers that their bills should be submitted to Medicare for processing and payment.  When necessary, report the accident to Medicare, so it can establish a subrogation file. Keep records of all medical treatment received and remind providers, in writing if necessary, to timely file all bills with Medicare. At the close of any claim, it’s also important that Medicare’s subrogation interest is addressed, and that reimbursement is made for any conditional payments that have been made.

Medicare provides essential coverage for car accident-related injuries. Your local injury attorney should be able to help you navigate the complexities of Medicare’s coordination of benefits, limitations, and claim processes to ensure the medical expenses are covered appropriately and that Medicare’s interests are also properly considered. Understanding these aspects and taking proactive steps can minimize out-of-pocket costs and streamline the claims process.

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Related Pages

Your Guide to Motor Vehicle Injury Settlements

Top 7 Treatments for Car Accident Injuries in Nebraska

10 Most Common Motor Vehicle Accident Injuries in Nebraska

12 Steps to Protect Yourself After an Auto/Pedestrian Accident

Treatment of Concussion Following a Car Accident