Can Medicare Pay for Medical Bills in a Car Accident?
- Learn how Medicare covers some common types of health care treatment that you might receive following a car accident, including hospitalization, ambulance transportation, physical therapy and prescription pain medication.
Medicare does cover injuries sustained in a car accident in the same way it would if your accident-related injuries were suffered by other means. This means that Medicare Advantage (Part C) and Medicare Supplement (Medigap) plans can also help you pay for car accident injuries, though in different ways.
In this guide, we’ll outline some of the health care services you might receive following a car accident and how Medicare would help pay for them.
Medicare Covers Ambulance Transportation, ER Treatment and More If You’ve Been in a Car Crash
Medicare Part B is part of Original Medicare (Part A and Part B) and will cover emergency ambulance transportation to the nearest facility that is able to treat your injuries in a car accident.
Part B also covers emergency room treatment including X-rays and diagnostic tests to evaluate your injuries.
If you are admitted to the hospital for treatment as an inpatient, the costs of your hospital stay will be covered by Medicare Part A. If you need surgery, Part A will cover your surgery when performed on an inpatient basis. Medicare Part B will cover your surgery if you receive it as an outpatient.
After you’re initially treated after your car accident, Medicare can also cover the following services and items:
- Follow-up doctor’s office appointments during your recovery from car accident injuries are covered by Medicare Part B.
- Medicare Part B covers outpatient physical therapy to recover from your car accident injuries. Part B does cover some home health services such as at-home physical therapy if your doctor certifies that you’re homebound.
- If you need any durable medical equipment (DME) such as crutches or braces, they will be covered by Part B.
- Medications that are administered by a doctor or nurse in a health care facility are typically covered by Part B. If you are prescribed pain medication after your car accident, it may be covered by a Medicare Part D prescription drug plan or a Medicare Advantage (Medicare Part C) plan that includes prescription drug coverage.
How Much Does Treatment for Car Accident Injuries Cost With Medicare?
How much your car accident injury treatment will cost you may depend on what types of treatment you get, and where.
Medicare Part A
Nearly all Medicare beneficiaries have Part A, and most beneficiaries do not pay a premium for it.
When you’re admitted to a hospital as an inpatient, you begin what’s called a “benefit period.” During each benefit period, you first have to meet a deductible of $1,484 (in 2021) before your Part A coverage kicks in. After you meet your deductible, you won’t owe any coinsurance for your hospital costs during the first 60 days of a hospital stay during your benefit period.
Your Part A benefit period ends when you have not received any inpatient care for 60 consecutive days.
If your inpatient hospital stay lasts longer than 60 days (which isn’t typical), you will owe coinsurance of $371 per day through day 90 of your stay per benefit period in 2021. After 91 and beyond, you will owe coinsurance of $742 for each “lifetime reserve day” you use. You only have 60 days total in your lifetime.
After you’ve used up all of your lifetime reserve days, you’re responsible for all additional daily coinsurance costs for an inpatient hospital stay during a benefit period.
Medicare Part B
Medicare Part B requires an annual deductible of $203 in 2021. Once you meet your Part B deductible, you will typically be charged a coinsurance cost of 20% of the remaining balance for your medical bills for services covered by Part B.
Medicare Advantage (Part C)
Medicare Advantage plans are sold by private insurance companies. By law, these plans are required to provide the same benefits that are offered by Part A and Part B. Most Medicare Advantage plans also offer additional benefits that Original Medicare doesn’t cover, such as prescription drug coverage. Many plans also offer benefits such as dental, vision and hearing care.
Because these plans are sold by private insurers, the deductibles and cost-sharing for each plan may vary. You can contact your plan carrier directly to learn more about what your plan covers and the costs included.
Medicare Part D Prescription Drug Plans
Medicare Part D plans are sold by private insurers and provide coverage for prescription drugs. Like Medicare Advantage plans, the deductibles, copayments or coinsurance may vary by plan.
Most commercially available prescription pain medication that’s available at retail pharmacies are covered by most Part D plans. You may pay lower costs for generic versions of drugs vs. name brand, depending on what tier those drugs are in your prescription drug plan drug formulary.
Medicare Supplement Insurance (Medigap)
Medigap plans, or Medicare Supplement Insurance, can help pay for out-of-pocket Medicare costs such as the Part A and B deductibles, copayments, coinsurance and other costs. A Medigap plan can help cover many of your remaining Medicare-related medical expenses after a car accident.
Does Medicare Cover Cosmetic Surgery?
Cosmetic surgery is not covered by Original Medicare except when needed to correct a serious health defect caused by injuries. If your car accident injuries are extensive and your doctor deems it medically necessary to get corrective cosmetic surgery, Medicare may cover your surgery.