Does Medicare/Medicaid Cover Injuries from a Car Accident in Illinois?

One of the most common questions clients ask us is, “Does Medicare/Medicaid cover injuries from a car accident?“ Understanding Medicare and Medicaid coverage is critical for Chicago car accident victims. These joint federal and state government programs may cover injuries, including emergency medical care, outpatient care, and prescription drugs. 

However, they typically require post-treatment reimbursement if you later receive a personal injury settlement. That means a portion of your medical expenses may be subject to a lien. 

An experienced attorney can help calculate post-treatment reimbursement, manage lien amounts, and factor healthcare providers’ bills and procurement costs into your claim.

Medicare vs. Medicaid Health Insurance and Car Accident Injuries

After a serious car accident, medical expenses and lost wages can quickly impact your financial situation. Programs like Medicare or Medicaid may help pay for treatment, but both have strict rules for repayment if you later receive a settlement.

Medicare is a federal program that provides medical coverage for individuals over 65 and some people with disabilities. If any part of your medical treatment is covered under Medicare, you may need to repay the program using part of your settlement. This includes coverage under Medicare Advantage. 

Medicaid is a joint state and federal program that offers coverage for low-income individuals. It helps cover medical expenses, prescription drugs, and outpatient care after a crash. In Illinois, the state has the legal right to recover what it spent. The lien amount is determined based on the final insurance coverage or settlement value, as allowed under state law.

Medicaid and medicare programs can affect how much you ultimately receive from a settlement. Working with a legal team can help protect your recovery and make sure nothing is missed during the claims process.

Does Medicare or Medicaid Cover Injuries from a Car Accident?

Medicare and Medicaid can cover injuries from a crash, but both programs require compensation if you receive a personal injury claim settlement.

Under Illinois law, Medicaid can place a lien on any recovery used to pay for medical care. Medicare operates similarly, including for those on Medicare Advantage plans. The lien amount depends on the benefits paid and must be resolved before funds are released.

These repayments count as procurement costs and can be reduced by attorney fees or other procurement costs. If the at-fault driver’s insurance company settles the case, the federal or state government may seek reimbursement. Ignoring a valid lien can result in double damages.

Since these programs only cover initial medical expenses, anyone relying on health insurance through government programs should account for the lien amount when settling a claim.

What Medical Bills Are Covered After a Car Accident?

After a car accident, treatment costs depend on several factors, including the severity of your condition, available coverage, and assistance through Medicare or Medicaid. Hospital stays are typically covered under Medicare Part A, while Medicare Part B includes outpatient services, diagnostic support, and medical equipment. 

Medicaid may help with long-term care, especially for low-income individuals, but acts as the payer of last resort and must be reimbursed if another responsible party is liable.

The amount Medicare or Medicaid expects in reimbursement is calculated using a specific formula and can be reduced by legal fees. Lost income may be addressed if the other driver has appropriate insurance. If the at-fault driver faces criminal charges, there may be other penalties beyond civil consequences.

Even younger individuals on Medicaid must repay a share of their settlement, depending on the type of treatment, care duration, and existing coverage.

Filing a Car Accident Injury Claim While on Medicare or Medicaid

Medicare or Medicaid may cover healthcare costs from a car accident, but that coverage comes with specific rules and obligations. If you’re on either program and file a personal injury claim, the appropriate agency must be notified. The benefits received are conditional and must be repaid if you receive compensation from a settlement or judgment.

For medical expenses related to your car accident, Medicare generally covers follow-up care, diagnostics, and therapy under Medicare Part B.  Medicaid can assist with long-term care, especially for low-income individuals. 

However, these programs are not primary payers when another party is responsible for the crash. Under Illinois law, Medicaid is considered the payer of last resort. It will assert a lien on your personal injury claim to recover costs if you collect damages from the at-fault driver.

The amount owed to Medicare and Medicaid is determined based on several factors, including the total amount recovered, your documented medical expenses, and the cost of procuring the settlement. 

Since both federal and state programs have strict reporting rules, it’s important to work with a Chicago car accident attorney who understands how to handle the claims process properly. Legal guidance can help navigate lien resolution, protect your recovery, and avoid delays in receiving what you’re owed after the car accident.

How Does a Conditional Payment Work in a Car Accident Settlement?

If you’re wondering, does Medicare/Medicaid cover injuries from a car accident? The answer is yes, but only as a temporary, conditional payment. These programs may pay for hospital care and rehabilitation upfront, but they must be reimbursed from your settlement or award. Failing to repay can lead to penalties or loss of future eligibility. 

If you’re filing a claim while on Medicare or Medicaid, it’s important to know how this affects your final settlement amount and access to future support.

How Are Medicare and Medicaid Liens Determined?

After a car accident, Medicare and Medicaid may place liens on your settlement to recover costs related to crash-related care. These claims cover things like emergency visits, follow-up treatment, and rehabilitation tied to the incident.

The lien amount reflects what was paid on your behalf, but some charges may not apply. An attorney can dispute unrelated assistance and seek reductions.

Under Illinois law, Medicaid liens may be reduced based on the amount awarded and the portion for non-medical losses. A lawyer can help negotiate a lower repayment amount.

How to Reduce or Negotiate a Medicare/Medicaid Lien in Illinois

If a government healthcare program has issued a claim for reimbursement after a car accident, there are legal options available to limit what must be returned.

Start by reviewing each charge carefully. If certain treatments were for unrelated health conditions, you can request that they be excluded from the repayment calculation. Detailed documentation and expert input can help show that some procedures were not connected to the crash.

Under the Illinois Healthcare Services Lien Act, reductions may be available when the recovery amount doesn’t cover the full extent of financial harm or when the repayment would place an undue burden on the injured person.

You can also request a hardship adjustment. In car accident cases involving shared fault, Illinois’ comparative fault statute may allow additional relief. Legal representation is especially useful here, as negotiating a fair outcome with Medicare and Medicaid requires knowledge of both state rules and federal program guidelines.

What Happens If You Fail to Repay a Medicare/Medicaid Lien?

Failing to resolve a Medicare or Medicaid lien after a car accident settlement can lead to serious consequences.

Legal action may follow. The Illinois Attorney General can sue to recover the unpaid amount tied to the treatment for injuries from a car accident. You could lose access to program entitlements. Future eligibility for Medicare and Medicaid may be affected, limiting your ability to receive care for new or worsening injuries.

Fines and interest may apply. Delayed repayment can trigger added financial penalties, which can reduce what you receive from your case. Resolving liens early helps avoid these setbacks and protects your recovery, especially when Medicare or Medicaid contributed to your care.

Get Legal Help for Your Accident-Related Medical Bills

A Chicago car accident attorney can help you navigate complex Medicare and Medicaid lien issues after a crash. They’ll negotiate with state agencies, challenge unrelated charges, and make sure you comply with the law. Their goal is to protect your settlement and reduce what you’re required to repay.

Contact a Chicago car accident lawyer today for a free consultation to better understand your options regarding Medicaid and Medicare after a car accident. Reach us at (888) 424-5757 or through our contact form.

All content undergoes thorough legal review by experienced attorneys, including Jonathan Rosenfeld. With 25 years of experience in personal injury law and over 100 years of combined legal expertise within our team, we ensure that every article is legally accurate, compliant, and reflects current legal standards.