Does Medicare Cover Auto Accident Injuries in Florida?

Yes, Medicare in Florida does provide coverage for injuries resulting from auto accidents. This means that if you're a Medicare beneficiary and you sustain injuries in a car accident, you can turn to your Medicare coverage to help bear the cost of your medical care. It's important to note that what will be covered depends on the specifics of your Medicare plan, as different plans come with different benefits.

What Does Medicare Cover for Auto Accident Injuries?

Coverage for auto accident injuries under Medicare is similar to coverage for any other type of injury or illness. Medically necessary services and supplies such as doctor visits, hospital stays, diagnostic tests, surgeries, and prescription drugs can be included. However, certain restrictions and limitations may apply because Medicare is usually a secondary payer in Florida (see below).

Medicare Part A will bear the costs related to your inpatient hospital treatment, such as the cost of any surgeries performed during your stay. Medicare Part B is applicable if your surgical procedures are conducted in an outpatient facility.

Following initial treatment after your car accident, Medicare Part B extends its coverage to a range of services and items such as:

• Subsequent doctor's appointments during your recovery period
• Outpatient physical therapy necessitated by your car accident injuries
• Home health services, including at-home physical therapy, as long as your doctor certifies your homebound status
• Durable medical equipment (DME), like crutches or braces
• Medications dispensed by a healthcare professional within a medical facility

Additionally, post-accident pain medications could be covered under a Medicare Part D prescription drug plan or a Medicare Advantage (Medicare Part C) plan, provided it includes prescription drug coverage.

Medicare and No-Fault Auto Insurance

Florida is a no-fault state, meaning that each driver’s insurance company pays for their medical expenses and damages, regardless of who caused the accident. Under Florida law, auto insurance must cover up to $10,000 in medical costs for accident injuries. Medicare is a secondary payer in this case and will only cover the remaining amount exceeding $10,000.

Medicare’s Secondary Payer Rules

Medicare’s secondary payer rules are designed to ensure that Medicare does not pay for the medical expenses that other insurers should cover. As a secondary payer, Medicare will cover costs that the primary insurer fails to pay or cover fully. Therefore, if a senior has auto insurance that covers their medical expenses, that insurance must pay their portion of medical bills before Medicare covers any costs.

Types of Medicare and Their Car Accident Coverage

Medicare coverage is divided into four parts, each providing different healthcare services.

• Medicare Part A will cover inpatient hospital care, including surgeries and skilled nursing facility care.‍
• Medicare Part B covers necessary medical services such as doctor's visits, outpatient care, and preventative services.
• Medicare Part C (Medicare Advantage plans) are offered by private insurance companies approved by Medicare. They provide the same coverage as Parts A and B, plus additional benefits such as prescription drug coverage.
• Medicare Supplement plans (Medigap plans) are designed to cover the out-of-pocket expenses that Original Medicare does not cover, such as deductibles and copayments.

Medicare does cover auto accident injuries in Florida, but the extent of coverage depends on the type of Medicare plan you have. It's essential to review your plan's benefits and limitations to understand what will be covered in case of an auto accident. If you have any questions or concerns, it's best to consult with a Medicare representative or your insurance provider for further clarification.