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Using Medicare After An Auto Accident


In Florida, auto accidents are most often handled by filing a claim with one’s insurance company using your personal injury protection (PIP) coverage. However, PIP coverage very often does not cover your total medical bills, and it is important to understand what other options may be available to you. If you have Medicare coverage, it may be a good idea to use it to help pay your bills – but Medicare does demand repayment under very specific conditions, and if you do not fully understand this, it can be an issue.

Which Insurance To Use?

Florida follows what is called a no-fault auto insurance system, which means that instead of filing a lawsuit against a driver who struck you, you would file a claim with your insurer for your medical bills and other damages like lost wages, auto repairs, and pain and suffering. Every Florida driver is required to carry at least $10,000 of PIP coverage, and $10,000 of property damage liability (PDL) coverage, though many choose to have a higher amount of coverage. If you are involved in an auto accident, and you seek treatment from a medical professional, your PIP coverage will be the first insurance that will be billed.

What many people do not realize is that PIP coverage is not required to cover every penny of your medical bills. The relevant law states that PIP must cover 80 percent of all “reasonable expenses for medically necessary” procedures and treatment. While the 20 percent remaining may not seem like much, it can add up to a significant amount, and it is for this 20 percent that other insurance coverage, such as Medicare or Medicaid, can be used. That said, one does not simply ask Medicare or Medicaid to pay, and using this coverage can sometimes lead to unpleasant surprises.

Beware Of Liens

Using Medicare or Medicaid coverage to help pay your bills after an accident has pros and cons. The pros of using this type of coverage is that both Medicare and Medicaid will pay out fairly quickly, especially Medicaid; it will only pay a fraction of the bill, but this means the program is more likely to pay out. Medicare, by comparison, is considered a ‘secondary payor,’ which means that it will pay out only if the injured person is not able to avail themselves of other insurance resources. When it does, it may also require repayment, under what is referred to as a Medicare lien.

A Medicare lien happens when Medicare makes a “conditional” payment for the covered person’s medical treatment. Because the payment is “conditional,” it is required to be paid back – either out of proceeds from a personal injury lawsuit settlement or award, or out of the insured’s pocket if they elect not to bring suit. It is possible to negotiate the payment of a Medicare lien, but trying to do it alone can be a painful and time-consuming process. Enlisting an attorney in this type of situation is often the difference between success and failure.

Call A Tampa PIP Coverage Attorney

Negotiating a claim with your PIP insurer can be very intimidating if you have never been in this position before. It is a better idea to contact a Tampa personal injury lawyer who has experience with the process and understands just how high the stakes are for you and your family. The Rinaldo Law Group has handled many of these cases, and is happy to try and assist you with yours. Contact our offices today for a free consultation.


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