Medicare covers auto accident injuries the same way it covers any other injury — through Part A and Part B, regardless of how the injury happened

Medicare does not have a separate category for accident injuries. If you are in a car accident and need emergency care, hospital admission, or follow-up treatment, Medicare Part A (hospital insurance) and Part B (medical insurance) pay their usual share. The accident itself does not change what Medicare covers or how much you pay out of pocket.

What changes is who else might pay. If another driver caused the accident, that driver's liability insurance may be required to reimburse Medicare for what it paid on your behalf — a process called Medicare recovery. This can affect your out-of-pocket costs and the timeline for settlement. Understanding this distinction matters because it shapes what you owe now and what happens later.

Key Takeaways

  • Medicare Part A and Part B cover emergency room visits, hospital stays, and doctor visits after a car accident just as they would for any other injury.
  • If another driver was at fault, their liability insurance may be required to reimburse Medicare for what it paid, which can delay your settlement.
  • You are responsible for your normal Medicare cost-sharing — deductibles, coinsurance, and copays — even when an accident occurs.
  • You must report the accident to Medicare and your supplemental or Medicare Advantage plan so they know a third party may owe reimbursement.
  • Settling a claim without notifying Medicare can result in Medicare placing a lien on your settlement or demanding repayment.

What Medicare Part A and Part B actually cover after an accident

Part A covers inpatient hospital stays, skilled nursing facility care, and hospice. If you are admitted to the hospital after a car accident, Part A pays 100% of covered costs after you meet your annual deductible (which resets each year). Part B covers doctor visits, emergency room care, ambulance transport, imaging, lab work, and outpatient procedures. Part B pays 80% of approved charges after you meet your deductible; you pay the remaining 20%.

These percentages and deductibles explore whether the injury came from a car accident, a fall at home, or any other cause. Medicare does not ask how the injury happened. However, if you have a Medigap supplemental plan or a Medicare Advantage plan, that plan may cover some or all of your cost-sharing, depending on your specific policy. You should contact your supplemental or Advantage plan when ready after the accident to report it and confirm what you owe.

Rehabilitation and physical therapy are covered under Part B if ordered by your doctor and deemed medically necessary. Prescription drugs are covered under Part D (your separate drug plan) at your plan's cost-sharing level. Durable medical equipment — crutches, walkers, wheelchairs — is covered under Part B at 80% after your deductible.

How liability insurance and Medicare recovery work

If another driver caused the accident and their liability insurance is responsible for your injuries, that insurance company is considered a primary payer — meaning it should pay first, before Medicare. Medicare is the secondary payer. However, liability insurance companies often move slowly, and you may need when ready care. Medicare will pay its share upfront, but it expects to be reimbursed once the liability claim is settled.

This reimbursement obligation is called Medicare recovery, and it is governed by the Medicare Secondary Payer (MSP) rules. Medicare has the legal right to recover what it paid from any settlement, judgment, or insurance payment you receive related to the accident. The amount Medicare can recover is limited to what it actually paid for treatment related to the accident — not your entire settlement.

For example: if Medicare paid $8,000 for your emergency room visit and hospital stay, and you later settle with the at-fault driver's insurance for $50,000, Medicare can demand reimbursement of up to $8,000 from that settlement. You do not pay this back out of your own pocket; it comes from the settlement proceeds. However, if you settle without notifying Medicare, Medicare may place a lien on the settlement or pursue you for repayment later.

Reporting the accident to Medicare and your insurance plans

You must report the accident to Medicare within 30 days if another party may be liable. You can report it by calling Medicare at 1-800-MEDICARE (1-800-633-4227) or by contacting your local Social Security office. Have the other driver's name, insurance company, and policy number ready. Medicare will note the accident in your file and track what it pays so it can recover later if needed.

You must also report the accident to your supplemental insurance plan (if you have Medigap) or your Medicare Advantage plan. These plans need to know that a third party may owe reimbursement so they can coordinate their own recovery efforts. Failure to report can result in your plan denying coverage or demanding repayment from you.

If you hire a personal injury attorney, inform them when ready that you are on Medicare. Attorneys experienced in accident claims know the Medicare recovery rules and will factor the Medicare lien into your settlement. Some attorneys will negotiate with Medicare to reduce the amount it recovers, though Medicare is not always willing to negotiate.

Your out-of-pocket costs during treatment

You still owe your normal Medicare cost-sharing while you are being treated. This means you pay your Part B deductible (currently $226 per year, though this amount changes annually), your 20% coinsurance on doctor visits and outpatient services, and any copays required by your supplemental or Advantage plan. These costs are your responsibility when ready, even though a liability claim may eventually cover them.

If you have a Medigap plan, it typically covers your Part B coinsurance, so you may owe nothing at the point of service. If you have a Medicare Advantage plan, your out-of-pocket costs depend on your specific plan — some have copays, some have coinsurance, and some have out-of-pocket maximums. Check your plan documents or call your plan's customer service line to confirm what you owe.

Keep all medical bills, receipts, and explanation of benefits statements from Medicare. These documents are essential for proving to the liability insurance company what Medicare paid and for calculating the Medicare lien later.

What happens if you settle without telling Medicare

Settling a liability claim without notifying Medicare is a serious mistake. If Medicare later discovers that you received a settlement related to the accident, it can place a lien on the settlement proceeds, demand repayment from you directly, or both. The lien means Medicare gets paid from your settlement before you do. If you have already spent the settlement money, you may be responsible for repaying Medicare out of your own funds.

Additionally, settling without Medicare's knowledge can trigger an overpayment investigation. Medicare may determine that it should not have paid anything because the liability insurance should have paid first. In that case, you could be held responsible for repaying the full amount Medicare paid, even if you have already settled with the other driver's insurance.

The safest approach is to inform Medicare and your supplemental or Advantage plan before you accept any settlement offer. Give them time to calculate their recovery amount. Most liability insurance companies are familiar with Medicare recovery and will wait for Medicare's lien letter before releasing settlement funds.

Uninsured or underinsured drivers and Medicare

If the at-fault driver has no insurance or insufficient insurance to cover your injuries, Medicare still pays its share of your medical costs. You cannot recover from Medicare for the gap. However, you may be able to recover from your own auto insurance if you carry uninsured or underinsured motorist coverage. This coverage is separate from Medicare and is governed by your auto insurance policy.

If you do recover from your own uninsured motorist coverage, you must still report this to Medicare. Medicare may attempt to recover what it paid from your uninsured motorist settlement, depending on your state's laws and the specific circumstances. Some states have laws that protect uninsured motorist settlements from Medicare recovery, but not all do. An attorney can advise you on your state's rules.

Frequently Asked Questions

Do I have to use Medicare for accident injuries, or can I use only the other driver's insurance?

You cannot refuse Medicare. If you are enrolled in Medicare and you receive medical care, Medicare is your insurance. The other driver's liability insurance is secondary and pays after Medicare. You can file a claim with the liability insurance company, but Medicare will still pay its share first.

Will Medicare deny my claim because the accident was someone else's fault?

No. Medicare covers medically necessary treatment regardless of the cause of injury. The fact that another driver caused the accident does not change what Medicare covers or whether it covers it.

Can I settle with the other driver's insurance without involving Medicare?

You can attempt to settle, but if Medicare paid anything for your treatment, you must notify Medicare before accepting the settlement. If you do not, Medicare can place a lien on your settlement or demand repayment. It is not worth the legal and financial risk to hide a settlement from Medicare.

How long does Medicare recovery take?

Medicare can take several months to calculate its recovery amount and send a lien letter to the liability insurance company. This is one reason liability insurance companies often delay settlement — they are waiting for Medicare's lien. Plan for the process to take at least two to three months after you file your claim.

What if I disagree with the amount Medicare says it paid?

You can request an itemized statement from Medicare showing exactly what it paid for each service related to the accident. If you believe Medicare made an error, you can file an appeal through the standard Medicare appeals process. However, this process is separate from your liability claim and can take additional time.