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Paying Medical Bills Post-Accident: Health Insurance



Following the first post of this series, in which we reviewed common terms related to getting medical expenses paid, as well as common sources of first- and third-party auto insurance coverage, this second post in our series describes how health insurance plays into post-accident medical expenses.

With the passage of the Affordable Care Act (aka “Obamacare”), many more people have access to health insurance; however, not all plans are treated the same with regard to subrogation. Below, we examine four of the most common types of health insurance.

Medicare

 

This is a Federal government health insurance plan for qualified participants who are age 65 or older, or for people with certain disabilities. Medicare is always subrogatable because it is a payer of last resort, which, means that Medicare will make conditional payments to allow the participant access to health care, but Medicare must be reimbursed for any past or future accident-related medical treatment.

Medicaid

 

This is a health insurance plan for qualified participants based on need and income requirements, which is administered by the States with funding from the Federal government. Like Medicare, Medicaid is always subrogatable and should be reimbursed once the accident victim receives payment from third party insurance.

Private Health Insurance (employer-based)

 

This is coverage that employees and their family members qualify for, where the employer and employee each pay a portion of the premium. Subrogation of these plans are State- and plan-specific and will be discussed in the third, “Roadmap,” post of this series.

Private Health Insurance (consumer-based)

 

This is coverage that is individually purchased by people who are self-employed or otherwise do not qualify for employer-based plans. Plans that were purchased on the health insurance marketplace most often fall under this category. Subrogation of these plans are State- and plan-specific and will be discussed in the third, “Roadmap,” post of this series. Consumers who meet income requirements for State assistance have the option to purchase a Medicaid plan, which is (as mentioned above) subrogatable and must be reimbursed once the accident victim receives payment from third party insurance.

MYTH: “If I have to reimburse my health insurance plan, I shouldn’t use those benefits.”

 

FACT: Using health insurance allows access to many doctors, especially specialists, who may be reluctant to wait for payment until an accident claim is resolved. Also, when an accident victim has to reimburse health insurance in subrogation, the reimbursement amount is only what the health insurance actually paid, not what the medical provider billed. Health insurance plans have pre-contracted rates with in-network providers that are deeply discounted, and patients get the benefit of that discount when using their health insurance coverage. In Maryland, the health insurance plan has to be reimbursed; however, when reimbursing private health insurance, there is a statutory right to a discount. See MD Code Sec. 11-112.

In our next post of this series, we lead readers through a Roadmap of tips for getting medical expenses paid around the beltway – in Virginia, then Maryland, then D.C. If you have questions about information in this series of posts related to Paying Medical Bills Post-Accident, or to speak with a lawyer from our Injury Law department, call 301-340-2020.

More in this Series:

Paying Medical Bills Post-Accident: Terms to Know

Paying Medical Bills Post-Accident: A Roadmap through VA, MD and DC


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