The federal Medicare program pays for the healthcare of people who have reached a certain age.
As is the case with many federal programs, the government takes steps to protect the bottom line of this federally funded healthcare program.
One of these steps is that Medicare will not pay medical care for injuries that are covered by workers’ compensation benefits until the workers’ compensation benefits are exhausted.
For injured and sick workers in the Bay Area who are either enrolled in or expect soon to enroll in Medicare, being unaware of these rules can prove costly.
For example, if a California resident enters a lump sum settlement for benefits without considering Medicare, Medicare will make sure to recover medical expenses it believes the Medicare program paid when workers’ compensation was available.
On the other hand, the worker will likely waive as part of their settlement their right to pursue further payments for their ongoing medical care. In the end, the injured or sick worker comes up short on payments for their medical expenses.
Alameda County workers should consider a Medicare Set-Aside Arrangement
An injured worker in Alameda County or Contra Costa County should consider adding a Medicare Set-Aside Arrangement to any settlement agreement they make for workers’ compensation benefits.
Preparing a settlement agreement with this type of Arrangement can be a complicated process. For example, it is important to make sure that an injured worker receives enough money to cover what Medicare believes its payouts for medical care will be.
Whether on Medicare or not, injured workers need to enter Compromise and Release settlements cautiously.
While the thought of getting a lump sum payment quickly is an attractive reason to settle a workers’ compensation claim fast, there is a reason why employers and insurance companies offer these agreements.
These agreements save them money, too often at the expense of the worker. Workers need to know their rights and alternatives to make sure they get a fair payment.