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How Medicare/Medicaid Affects Car Accident Injury Claims

Healthcare professional showing patient a medical form in the waiting room.

If you were involved in a severe wreck that you did not cause and rely on Medicare or Medicaid for healthcare benefits, you may be wondering what you are covered for and whether you are allowed to file a personal injury claim.

The good news: an injured party is allowed to file a personal injury claim against an at-fault driver if there is evidence of negligence and the claim is made within two years of the date of the accident.

The unfortunate news: Medicare and Medicaid are required to be reimbursed for covering medical treatment from the final personal injury settlement amount.

Why File a Personal Injury Claim If I Have Medicare or Medicaid?

Submitting a claim with the at-fault driver’s insurance ensures the burden of treatment costs are shouldered by the insurance company after going through Medicare or Medicaid, and not onto you.

However, this is easier said than done. Insurance and healthcare have layers and layers of complicated bureaucracy and unexpected deadlines and forms. Medicare and Medicaid are usually entitled to be reimbursed for treatment expenses if a case successfully settles.

A personal injury lawyer can help an injured car accident victim understand their options so they can achieve the best settlement outcome possible.

If you were injured in a serious car wreck in Georgia and are on Medicaid, Medicare, or both, contact an Atlanta car accident lawyer at Gary Martin Hays & Associates. We offer free consultations to potential clients regarding their rights and next steps.

Does Medicare or Medicaid Cover Car Accident Injuries?

Yes, but there are some caveats compared to how private health insurance handles personal injury claims.

In a typical car accident case, the injured person undergoes treatment. When they are done treating, they collect all of their medical records, bills, and provider information and submit all of it to the insurance company for evaluation.

The insurance company will review the accident report, treatment costs, and all insurance coverages available. From that, they will provide a settlement offer if there is any money leftover after treatment. The initial offer is often low, so having an attorney can help you negotiate a higher settlement amount.

Worker going through aisle filled with medical records.

Medicare and Medicaid add additional hoops to the personal injury claim process.

Because a government service is being used, there will be a lien (a legal right to assets used as collateral to satisfy a debt) placed on the entire recovery amount.

What this means is the government makes a conditional payment so you do not have to pay out-of-pocket for medical care. Repayment to Medicare or Medicaid is made when there is a settlement, award, judgment or other type of payment at the end.

When you receive a settlement amount from the insurance company for a car accident, any liens in place by Medicare or Medicaid must be repaid first. Failure to do so will likely result in the federal or state government suing the injured party and their attorney for double damages plus interest. Loss of coverage, criminal charges, and other penalties may be issued as well.

Medicare plans are divided into Part A and Part B:

  • Medicare Part A - Recovers any money paid by Medicare to any hospitals or nursing homes for injuries you sustained in the wreck.
  • Medicare Part B - Recovers any amount paid by Medicare to doctors.

There is a specific formula that Medicare uses to calculate post-treatment reimbursement. Sometimes though, Medicare records include unrelated doctors and treatment dates. It’s important to catch these errors and have the records corrected to get the lien amount reduced.

When our attorneys see these liens, we always make sure that the medical bills included in the lien amount were actually incurred due to treatment for injuries sustained in the wreck.

Medicaid plans experience similar issues.

For example, here in the state of Georgia the Department of Community Health will put a lien on your personal injury claim based upon the amount they paid to your health care providers. Like Medicare, unrelated items may be lumped in with the treatment that was reasonable and necessary.

You should consult with an attorney after a car accident to make sure you don’t pay more than you owe.

Consult a Lawyer Specializing in Car Accident Claims

Insurance is complicated. In addition to painful injuries, you may be dealing with a disability, chronic health issue, and loss of financial stability. It’s all so much to process at once.

Don’t let anxiety paralyze you. A capable attorney can be your ally. Talking to one can help you better understand your situation and legal rights. Hiring an attorney can get you the settlement result you deserve for all of your pain and suffering.

At Gary Martin Hays & Associates, we’re here to guide car accident victims through every step of the process. We have personal injury lawyers familiar with Medicare, Medicaid, and Social Security law.

When you hire us, we will immediately contact CMS (Center for Medicare and Medicaid Services) to notify them that the claims process has begun. Protect yourself by contacting our car accident law firm first at (770) 934-8000 or by starting a live chat.

We can’t change what happened, but we can provide compassionate expertise that puts you at ease from beginning to end.

Contacting Medicare & Medicaid

What Is Medicare?

Medicare is a government program that provides health insurance for people 65 and older. Other people may qualify to receive Medicare earlier if they have a disability, ESRD, or ALS (Lou Gehrig’s disease). Benefits and drug coverage vary depending on if a person starts getting Social Security benefits before turning 65 or wants Medicare when they turn 65 but don’t want to draw retirement benefits yet.

Medicare - Social Security Administration
Primary: 1 (800) MEDICARE / 1 (800) 633-4227
TTY Users: 1 (877) 486-2048
Hours: 24/7 (except some federal holidays)

What Is Medicaid?

Medicaid is a joint federal and state government health program that helps cover medical costs for certain low-income individuals. While there are overall rules all Medicaid programs must follow, benefits and eligibility requirements vary from state to state.

Georgia Department of Community Health
Primary: (404) 656-4507
Constituent Services: (404) 656-4496
Address: 2 Martin Luther King Jr. Drive SE East Tower, Atlanta, GA 30334 US
Hours: M-F, 8 am - 5 pm EST

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