According to the Centers for Disease Control and Prevention (CDC), over 2 million people are injured in car accidents each year. If you are one of those people, it’s normal to wonder how you will pay your medical expenses if you are injured.
The good news is that, if you have Medicare, most of your medical expenses are generally covered. Even if you are covered under an automobile liability claim, Medicare may pick up the costs for any covered medical expenses the auto policy missed.
Here’s a look at your car accident coverage under Medicare.
Should I see a doctor for my car accident injuries?
If you suffer serious car accident injuries, or if the first responders suspect serious injury, you will likely be transported by ambulance to the hospital. Medicare Part B covers the allowable charges for emergency ambulance transportation to the closest appropriate facility; you pay 20% plus any applicable deductible. Part B also pays allowable charges for your treatment in the emergency room, less any applicable deductibles and coinsurance amounts. Your Medicare Part B benefit may cover your doctor visit as well as any x-rays or other diagnostic tests you need to evaluate your injuries in the emergency room.
If you are admitted to the hospital for car accident injuries, Medicare Part A generally covers allowable charges for your inpatient care, less your Part A deductible and coinsurance amounts.
If you were not taken to the hospital directly after your car accident, you may still develop signs of car accident injuries that should be evaluated by a doctor. The Mayo Clinic suggests seeking medical care if you develop any of the following symptoms of whiplash after a car accident:
- Neck pain and stiffness
- Tingling or numbness in the limbs
- Dizziness, blurred vision, or ringing in the ears
- Difficulty concentrating
- Memory problems
What other medical expenses for car accident injuries are covered by Medicare?
In general, any medically necessary treatment your doctor recommends for your car accident injuries is covered under Original Medicare (Part A and Part B). Specific benefits include:
- Outpatient physical and occupational therapy for car accident injuries is generally covered under Medicare Part B, up to the therapy cap limit. In 2019, the limit is $2,040 for physical therapy and speech-language therapy combined, and $2,040 for occupational therapy. Your Medicare Part B deductible and coinsurance amounts apply.
- Arm, leg, back, and neck braces are covered under Medicare Part B, subject to the requirements for durable medical equipment (DME). Both your doctor and the DME supplier must participate in Medicare, and in some areas, you may be subject to the competitive bidding program, which limits your choice of suppliers to those contracted with Medicare. You pay 20% of the allowable charges plus any applicable Part B deductible.
- Outpatient x-rays and diagnostic imaging after the accident are generally covered under Medicare Part B; you pay 20% of the allowable charges after your annual Part B deductible is met.
- Chiropractic services to correct a subluxation of the spine following a car accident are covered at 80% of allowable charges under Medicare Part B. Keep in mind, however, that Medicare does not cover x-rays ordered by a chiropractor, or other ancillary services such as massage therapy or acupuncture your chiropractor may recommend. Your Medicare Part B deductible applies.
- Prescription medications administered while you are an inpatient in the hospital are generally covered under Medicare Part A. Oral medications given in the emergency room or as an outpatient in an urgent care facility, as well as medications you take at home such as pain relievers, muscle relaxers, and antibiotics, may be covered under your Medicare Part D Prescription Drug Plan. If you receive IV medications, or injectable prescription drugs in the emergency room or urgent care center, these are generally covered under Part B. Keep in mind, you may be responsible for deductibles, copayments, or coinsurance amounts for your prescription medications, depending on your plan.
- Cosmetic surgery needed to correct a defect caused by car accident injuries may be covered by Original Medicare, less any applicable deductibles and coinsurance amounts.
- Outpatient mental health care, including visits with a psychiatrist, psychologist, social worker, nurse practitioner, or physician assistant, is generally covered under Part B, less your annual deductible and coinsurance amount. If you get mental health care in a hospital outpatient department, you may also pay an additional copayment.