Medicare Coverage for Auto Accident Injuries in Texas

Car wrecks bring a lot more than dents and forms to fill out. You are dealing with pain, unexpected bills, and the worry that comes with time off work. At the Law Office of Shane R. Kadlec, we have stood with injured people in Houston and nearby communities, and we understand how these moments shake a family.

This article explains how Medicare works with Texas auto accident claims. We will cover what is paid, when repayment begins, and how a lien can impact your settlement. If questions pop up while reading, we welcome your call.

Overview of Medicare and Auto Accident Claims in Texas

Medicare is a federal health insurance program for individuals 65 and older, as well as for those with specific disabilities or end-stage renal disease. After a crash, Medicare can cover injury care that falls within the rules of Parts A and B. That coverage can help you get treated right away, even while the insurance claim is still pending.

In Texas, the system is fault-based, so the driver who caused the crash is generally responsible for the harm. Medicare often steps in with what it calls conditional payments, then asks for reimbursement if you recover money from the at-fault driver’s insurer. That pay-now, repay-later setup keeps treatment moving without waiting on the claim.

Medicare Parts A and B: Coverage After a Car Accident

Medicare is split into parts. For car crash injuries, the most common are Part A for hospital care and Part B for outpatient and doctor services. Here is how they usually apply after a wreck.

Medicare Part A Coverage

Part A covers inpatient hospital care, skilled nursing facility care, and certain home health services that are provided following a hospital stay. If your injuries require admission, Part A helps cover the costs of room and board, nursing care, meals, and medically necessary supplies. Surgery in the hospital and related inpatient services also fall under Part A.

Part A is not free care. A deductible applies per benefit period, and coinsurance may be applicable for stays exceeding a specific duration. Those amounts are subject to change from time to time, so please check your current notices or ask us to review them with you.

If you move to a skilled nursing facility after the hospital, Part A can help there, too, when rules are met. The coverage window and daily coinsurance are limited, making it crucial to plan your next steps.

Medicare Part B Coverage

Part B handles outpatient services, doctor visits, preventive care, diagnostic tests, and durable medical equipment. After a crash, that typically includes ambulance transport to the nearest suitable facility, emergency room physician services, X-rays, CT scans, MRIs, and follow-up visits.

Coverage under Part B turns on medical necessity. A service must be reasonable and needed for diagnosis or treatment, which your medical records should show clearly. You pay a monthly premium, an annual deductible, and usually 20 percent coinsurance on the Medicare-approved amount.

Part B also helps with items like braces, walkers, and crutches as durable medical equipment when your doctor orders them. Ensure that both your physician and supplier participate in Medicare to help keep costs down.

The quick view below illustrates how common post-crash services align with Medicare parts and typical cost-sharing.

Service	Medicare Part	What It Helps Pay	Typical Cost to You
Hospital admission after the crash	Part A	Room and board, nursing, supplies, inpatient surgery	Part A deductible, possible coinsurance for more extended stays
Skilled nursing facility care	Part A	Rehab and nursing after a qualifying hospital stay	Daily coinsurance after a limited period
Ambulance to the ER	Part B	Emergency ground or air transport when needed	Annual deductible, then usually 20% coinsurance
ER doctor and imaging	Part B	Physician services, X-rays, CT, MRI	Annual deductible, then usually 20% coinsurance
Follow-up visits and therapy	Part B	Office visits, physical or occupational therapy	Annual deductible, then usually 20% coinsurance
Braces, crutches, walkers	Part B	Durable medical equipment ordered by your doctor	Annual deductible, then usually 20% coinsurance

How Medicare Coordinates Benefits with Car Insurance in Texas

In Texas, the at-fault driver is held responsible for damages, including medical expenses, lost wages, and other related costs. Still, health care cannot wait for a claim decision. That is why Medicare often pays first as a conditional payer, then seeks reimbursement from the settlement.

Medicare is usually secondary when a car policy covers health costs. It can help balance your auto coverage that does not fully cover the service, as long as Medicare covers the service. Every case is a little different, but the general order of payers looks like this.

• Your own PIP or MedPay, if you carry it, pays first within its limits.
• The at-fault driver’s liability insurance pays next if fault is accepted.
• Your Uninsured Motorist (UM) or Under-Insured Motorist (UIM) coverage can step in if the other driver has too little insurance.
• Medicare pays as secondary for covered services and then requests repayment from your recovery.

If bills slip past auto coverage or a carrier delays payment, Medicare can fill the gap, allowing treatment to continue uninterrupted. That is a significant relief during a tough time.

Filing a Personal Injury Claim with Medicare

If someone else caused the crash and you are a Medicare beneficiary, you can file a personal injury claim. That claim seeks payment for medical costs, lost income, pain, and other losses recognised under Texas law. Fast notice to Medicare is part of this process.

Once a claim is opened, report it to Medicare right away. This creates a recovery file and helps avoid mix-ups later. A personal injury attorney who handles Medicare issues in Texas can coordinate the reports and keep your records in line.

Here is a simple roadmap many clients follow after a crash in Texas:

1. Seek medical care and inform your healthcare providers that the injuries resulted from a car wreck.
2. Open a claim with the at-fault insurer and your own insurer, if applicable.
3. Report the injury claim to Medicare so that a recovery file can be set up.
4. Collect medical records and bills, and keep every EOB you receive.
5. Work with a car accident attorney to build the case and protect your settlement from errors in the lien.

Texas gives you two years from the crash date to file a lawsuit for personal injuries. Missing that deadline can shut the door on your case, so do not wait to start.

Medicare Liens and Reimbursement

Medicare has a lien on your injury recovery for the amounts it paid related to the crash. The lien should include only accident-related charges that Medicare actually paid. Before any settlement funds go to you, that lien must be satisfied.

The starting lien number is not always perfect. Billing windows often overlap with older care, and unrelated charges can inadvertently be included. We review every line item so your repayment is accurate.

There is room to push back on the lien when the math is off. Common approaches include:

• Pointing out treatment that had nothing to do with the crash injuries.
• Applying fair reductions tied to attorney fees and case costs required to obtain the recovery.
• Requesting hardship relief in rare cases where allowed.
• Correcting coding errors that inflated the claimed amount.

With a clean ledger, you repay what is owed, then the rest of the settlement can be released to you. Careful review helps protect your bottom line.

The Medicare Benefits Coordination & Recovery Center (BCRC)

The BCRC identifies and recovers payments that Medicare made, which actually belong to another payer, such as a liability insurer. It gets information from you, your providers, insurers, and your lawyer. Once the BCRC has your claim, it issues conditional payment letters and later a final demand after settlement.

If you receive letters from the BCRC, do not ignore them. Share them with your attorney so the file remains up to date and objections are submitted on time. Clear communication with the BCRC helps reduce delays when your case is resolved.

If the BCRC is seeking reimbursement and you are unsure what to do next, you can talk with our team. We regularly review payment summaries and dispute unrelated charges.

Importance of Seeking Medical Attention

After a wreck, get checked as soon as you can, even if you feel “okay.” Some injuries do not exhibit full symptoms until hours or days later, especially those involving the neck and back. Early records help your health and your claim.

Part B covers emergency ambulance transport when needed and treatment in the emergency room. If the ER discharges you, follow up with your primary doctor or a specialist to document the course of care. That paper trail is worth its weight in gold.

Watch for warning signs that can show up later and head back to a doctor if they appear:

• Neck pain, headaches, or dizziness that worsen instead of easing up.
• Numbness or tingling in arms, hands, legs, or feet.
• New vision changes, confusion, or trouble concentrating.

Prompt care supports healing, and it clearly ties the treatment to the crash, which is essential for both Medicare and insurance carriers.

Get the Assistance You Need After a Car Accident

Since 1996, the Law Office of Shane R. Kadlec has helped injured Texans get medical, financial, and emotional support after serious crashes. If a Medicare lien or a stubborn insurance carrier is adding stress, we can take that off your plate. Free consultations are available, and we are happy to review your Medicare letters and explain the next steps.

Feel free to call us at 281-643-2000. You can also reach our team through our Contact Us page for quick help. We work diligently to achieve outcomes that safeguard your health, benefits, and recovery.