Does Medicare Cover Auto Accidents in North Carolina?

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When you have car accident medical expenses, you will probably need extensive care before you can receive any settlement check. If you cannot prove that another driver was liable, you may not even be in a position for a settlement at all. Accident victims who are on Medicare often want to know if the government health coverage program will pay for auto accident medical expenses.

Medicare Will Act as a Health Insurance Provider

If you have suffered an injury in a car accident, Medicare will cover health insurance expenses just like any other health insurance provider will in the interim, provided that you are enrolled in Medicare Part B. This part of Medicare is the one that functions as your health insurance.

Although Medicare does not function as a car insurance company will, it covers the cost of your medical treatment associated with your car accident.

If you are receiving coverage from Medicare, they should cover all the medical expenses involved in your care.

You may also have the following special benefits under Medicare Parts A and B:

  • Outpatient physical and occupational therapy
  • Braces and certain medical equipment (subject to a deductible and copayment)
  • Outpatient x-rays and diagnostic imaging
  • Physical therapy
  • Prescription medication
  • Cosmetic surgery

You Need to Inform Medicare of Your Claim

You will need to notify Medicare about your car accident. Federal law requires that you contact the agency to report the claim. Medicare has a coordination of benefits contractor you must inform of the accident as soon as possible to give the agency the opportunity to verify coverage.

You will need to give Medicare the names of your doctors and perhaps the contact information for your attorney.

Medicare Is Not Your Primary Coverage If Your Car Insurance Policy Covers Damages

Medicare is your secondary insurance provider after your car accident insurance coverage is exhausted. If you are successful in getting a settlement check for your car accident injuries, Medicare may expect your auto insurance company to pay for its share of your coverage based on the language of your policy.

You may have personal injury protection as part of your auto insurance policy. Medicare may not cover certain medical treatments until after your car insurance coverage has been exhausted.

Medicare Must Be Reimbursed If and When You Get a Settlement

There are Medicare regulations called Medicare Secondary Provider rules. The government does not want to pay for expenses that can be covered in some other way. Therefore, Medicare must be reimbursed in the same way as any other insurance company once you get a personal injury settlement for your car accident. Like any other insurance provider, Medicare may have a lien against your settlement that must be paid before you can receive any money.

Therefore, you must make sure that you have negotiated an adequate settlement to cover your past and future medical expenses. Some people make the mistake of accepting far less money than they deserve, and then they can only cover their medical expenses. Our personal injury lawyers will value your case and fight for you to receive the maximum possible compensation.

It is not always easy to reimburse Medicare because there are many rules for how and when you can pay them back. The good news is that you can deduct attorney’s fees and costs from the amount that you pay them. Since these rules are complex, you should have the help of an experienced attorney.

It is crucial that your settlement agreement specifies exactly what the line items are. Medicare can only claim reimbursement against the medical expenses portion of your settlement. They cannot be paid back from pain and suffering or lost wages (or anything else besides medical expenses). Still, you cannot escape Medicare scrutiny if you undervalue medical expenses in your settlement. It is the court that will allocate certain amounts to each line item of the damages check.

Medicare will continue to monitor your case to check whether you have received a settlement. They may send certain information requests to your attorney in the meantime so that they can stay informed. It is always best to respond to Medicare’s requests for information because they will need to release the lien for you to receive any money from your settlement.

When you are dealing with multiple insurance providers and the other driver’s insurance company, there are many things that you need to track. These are tasks you may not handle on your own, especially when you are dealing with your own injuries. These types of claims can be detail-intensive when you may not have much capacity.

You should hire an attorney for these cases, both because of the complexity and the sheer amount of administrative details. Your lawyer will communicate with Medicare and respond to all requests for information.

Contact a Wilmington Car Accident Attorney Today

The car accident lawyers at Horton & Mendez Injury Attorneys handle complex car accident cases, including those where there is a multitude of entities involved. We try to make your life easier so that you can focus on your own health situation while fighting for maximum financial compensation for you.

To schedule your free initial consultation, you can send us a message online or contact us at (910) 668-8067.

Car Accident Medicare Coverage FAQs

Why do I need to be extra careful about Medicare claims?

Medicare is very aggressive about prosecuting potential fraud, which can include false statements in claims.

When should I hire a lawyer after a car accident?

You should hire an attorney as soon as possible after your accident, exactly because of these types of issues with Medicare.

What happens with my copayments and cost share?

You will also be reimbursed for the money that you have spent on your own medical care if you get a settlement.

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