Does Medicare Cover My Injuries If I Was at Fault
Medicare doesn't ask who caused the crash. It covers your care, then it may ask to be paid back.
Yes, Medicare covers your treatment regardless of fault
Medicare pays for medically necessary care after a car accident whether you caused it or not. It isn't like your auto insurer, which may look at fault to decide what it owes you. Medicare looks at whether you're enrolled and whether the treatment is medically necessary.
What changes isn't whether Medicare pays. It's who pays first, and whether Medicare expects some of that money back later. If your auto policy includes medical payments coverage or personal injury protection, that coverage usually has to pay before Medicare does. Medicare can also place a claim on any settlement you receive later, even if the crash was your fault.
Whether you have other coverage that has to pay first
Medicare is usually the secondary payer after a car accident, not the first one. If your state requires personal injury protection or you carry medical payments coverage, that coverage typically has to pay your medical bills up to its limit before Medicare steps in.
This matters even when you were at fault, because fault doesn't change the order of payment. Your auto coverage pays what it owes based on your policy terms, not based on who caused the accident.
Check your policy for medical payments coverage or personal injury protection, and call your insurer to ask how a claim from this accident would be handled. If you're not sure what your state requires, your insurer or your state's insurance department can tell you.
Once that coverage is used up, or if you don't have any, Medicare can pay for your remaining treatment.
Whether Medicare asks to be paid back later
If you later receive a settlement or a judgment from the accident, even one where you were found at fault, Medicare can seek repayment for what it paid toward your treatment. This is separate from whether Medicare paid your claims in the first place.
This repayment process exists because Medicare is meant to be a backup payer, not the only one. If another source of money related to the accident becomes available, Medicare expects a share of it.
Keep records of what Medicare pays for your treatment after the accident. If a settlement is involved, your attorney or the party handling the settlement should account for a potential Medicare repayment before the money is distributed.
This applies whether or not you were at fault. Fault affects liability and what your auto insurer owes. It doesn't affect whether Medicare was owed money back.
Questions people ask about this
Does my auto insurance have to pay before Medicare does?
If you have medical payments coverage or personal injury protection, yes, that typically pays first. Medicare generally pays after those benefits are used up or if you don't have that coverage. Check your policy or ask your insurer how it's set up.
Will being at fault raise my auto insurance rates even if Medicare paid my medical bills?
Being at fault can affect your rates regardless of who paid your medical bills. Medicare paying your treatment doesn't change how your insurer evaluates the accident for rating purposes. Ask your insurer how an at-fault accident is treated under your policy.
Does Medicare cover a passenger who was injured in my car?
Medicare covers its own enrollees, so a passenger who is enrolled in Medicare would have their treatment covered the same way yours would. A passenger who isn't enrolled in Medicare would need to rely on other coverage, like your auto medical payments coverage or their own health insurance.
Can Medicare refuse to pay because I caused the accident?
Medicare doesn't deny claims based on fault. It may ask other coverage, like your auto medical payments coverage, to pay first, but it doesn't refuse your treatment because you were responsible for the crash.
Do I need to report the accident to Medicare?
If Medicare pays for treatment related to an accident where another settlement or insurance payment may also apply, you may need to report the accident so Medicare can coordinate payment and any repayment correctly. Ask Medicare or the Benefits Coordination and Recovery Center directly about your situation.
See how your coverage choices might affect what you'd owe after an accident.
Pull out your auto policy and check whether you have medical payments coverage or personal injury protection, and note the limit. Call your insurer and ask directly how a claim from this accident would be paid, and whether Medicare would be billed afterward. If you expect any settlement from the accident, ask whoever is handling it how a Medicare repayment would be accounted for. Keep copies of your medical bills and any Medicare statements related to the treatment. If you're unsure how your state's rules affect the order of payment, your state insurance department can explain what applies to you.
