Medicare can cover eligible medical care after an accident, subject to its normal service rules and coordination with other insurance. There is no separate Medicare “accident plan” that automatically pays every expense or replaces an automobile or liability policy.
Determine which insurance pays first
For an injury connected to a liability, no-fault or workers' compensation claim, that coverage generally has primary responsibility for related medical services. Tell the treating office about the incident and every relevant insurer. Unrelated medical care may follow a different payment order.
| Possible expense | What to check |
|---|---|
| Hospital and professional care | Medical coverage rules and primary payer. |
| Rehabilitation or equipment | Separate eligibility, orders and limits. |
| Vehicle repairs or lost earnings | These are not Medicare medical benefits. |
| Long-term personal assistance | Do not assume all custodial services are covered. |
Report the claim information
CMS directs beneficiaries to report applicable accident and recovery information to the Benefits Coordination & Recovery Center. Keep the incident date, claim number, insurer details and correspondence. The reporting process helps identify responsibility; it does not decide who caused an accident.
In some circumstances Medicare makes a conditional payment while the responsible insurer's payment is pending. Conditional payments can require repayment after a settlement, judgment or other recovery. Ask the recovery office and your authorized representative how the rules apply before distributing settlement funds.
Review the medical bills
- Check that the provider has the correct insurance order.
- Match charges with services actually received.
- Keep insurer decisions and Medicare notices.
- Use the appeal instructions for an actual denial.
Medicare Advantage members should also contact their plan about accident-related billing and recovery. Coverage depends on the service, not simply on whether the injury happened at home, in a car or on a motorcycle.
Related coverage questions
- Original Medicare: What Parts A and B Cover and How You Pay
- A Medicare Medical Claim Was Denied: What to Do Next
- How to Compare Medicare Advantage Plans: A Practical Worksheet