Will Medicare cover accidental injury

Accidental injuries are a generally covered type of injury among all insurance programs. General accidental injuries, injuries from car accidents, and injuries from work-related accidents are all forms of injuries that Medicare may cover. However, depending on the type of accident, Medicare may require another entity to pay first before it pays any part of the claim. 

Injuries caused by car accidents

Although car accidents happen among all age groups, due to the increase in senior drivers over the years, the 65+ age group has seen a higher rate of car accidents. Over 250,000 people ages 65 and older were treated medically in 2017 as a result of a car accident.

Since 65 is the new 55, the likelihood of seniors continuing to drive well into their 80s is higher. Therefore, Medicare may start to see more claims resulting from injuries caused by car accidents. While Medicare does cover medically necessary treatment after a car accident, your personal injury protection through your car insurance will likely be the primary payer.

If you experience an injury from a car accident and go to the hospital, you will initially be able to use your Medicare coverage for the bill. However, Medicare requires you to formally report that you were in an accident and which medical visits resulted from it. This is because Medicare is the secondary payer and will need to be reimbursed by your car insurance provider.

On the other hand, if you can have your car insurance provider pay first on your medical bills that resulted from the accident and have Medicare pay secondary, then there will be no need for additional paperwork to reimburse Medicare.

Work-related injuries

In recent years, there has been a spike in senior workers. In 1996, only 12% of people 65 or older were still working, whereas 19% of people 65 and older are working currently. It is estimated that the percentage will rise to 22% by 2026.

With more seniors in the workforce, work-related injuries are steadily growing. According to the National Safety Council, in 2018, over 140 million workers were covered by workers’ compensation in 2017. Of those covered by workers’ compensation, over $60 billion was paid out on supplemental income and medical bills to the ones who made claims.

Similar to car accidents, Medicare pays secondary to workers’ compensation. If the workers’ compensation claim is paid promptly within 120 days, Medicare won’t pay for those claims. However, since the turnaround time for workers’ compensation payments can be slow, Medicare may pay claims that have been pending for 120 days or longer.

Medicare may also pay for claims denied by workers’ compensation if the services are covered by Medicare and you provide accurate documentation of denial. There are cases where workers’ compensation may only pay part of a claim and Medicare may pay the other part. For example, this is true if you had a pre-existing condition before starting the job, and the job made the condition worse.

How Medicare covers accidental injuries

When you suffer an accidental injury, regardless of the cause, Medicare will pay for medically necessary services to treat the injury. Medicare Part B will cover your doctor exams, lab work, x-rays, MRIs, surgery, and other outpatient services. If you are admitted to a hospital, then Medicare Part A will cover your stay.

Medicare Part B has an annual deductible of $198 in 2020. After you have paid this out-of-pocket, Part B covers 80% of allowable charges. You will be responsible for 20% unless you have a Medigap plan that covers the Part B coinsurance for you.

Part A also has a deductible that is $1,408 per benefit period. If your hospital stay extends past 60 days, you will have a daily copay. Your doctor may recommend you finish your recovery at a skilled nursing facility. If you were an inpatient for at least three days, Part A will cover the first 20 days during your skilled nursing facility stay.

Medicare does cover accidental injuries. However, how and when Medicare covers the injury can vary depending on the cause of the injury.

Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits, where her team of experts help baby boomers with their Medicare decisions nationwide.