'My head hit the driver's window': A teenager T-boned our car. Will Medicare pay my hospital bills?

By Quentin Fottrell

'My car was nearly 20 years old, and I only carried liability and uninsured motorist coverage, not collision coverage'

"I'm basically in a holding pattern." (Photo subject is a model.)

Dear Quentin,

My wife and I are both on Medicare. She is 67 and works part-time; I'm 69 and still work full-time. We were recently involved in a car accident when a teenage driver ran a stop sign and struck our car directly in the driver's door.

My head hit the driver's window pretty hard, and my wife injured her wrist. The fire department responded and checked our blood pressure and pulse, but both vehicles had to be towed from the scene.

The next day, I saw my primary-care doctor. Because of my age and some existing health conditions, he was concerned about the possibility of a brain bleed and sent me to the ER for a CT scan of my head, and X-rays of my shoulder.

At the ER, I told them my injuries were the result of a motor-vehicle accident, and I used my Medicare coverage for the visit. I'm hoping you can explain how Medicare works in a situation like this when the other driver is at fault. I'm planning to start physical therapy.

The accident report hasn't been posted yet. The state trooper told me the other driver was at fault. I contacted the other driver's insurance company, and they said they're waiting for the accident report before moving forward - so I'm basically in a holding pattern.

My car was nearly 20 years old, and I only carried liability and uninsured motorist coverage, not collision. My insurance company told me to work directly with the other driver's insurance company regarding the damage to my vehicle.

Should I continue using Medicare for treatment? Does the other driver's auto insurance pay first, or does Medicare? Do I need to tell the hospital to bill someone other than Medicare? Will Medicare seek reimbursement later if the other driver's insurance settles the claim?

The Driver

Related: My wife's 2011 Ford Fiesta was totaled. Should we accept a $2,000 insurance settlement or give up the car for $2,700?

You can email The Moneyist with any financial and ethical questions at qfottrell@marketwatch.com. The Moneyist regrets he cannot reply to questions individually.

If you later receive a settlement from the teen driver's insurance company, Medicare would be reimbursed for any conditional payments it made in the immediate aftermath of the car accident.

Dear Driver,

You need the three Ps: patience, paperwork and perseverance.

Conditional payments are standard practice and allow you to receive medical care, like CT scans and X-rays.

When someone else is at fault for an automobile accident, Medicare can pay your accident-related medical bills if the liability insurer isn't paying promptly, so you don't have to delay treatment or pay the bills yourself while the claim is pending. In this case, the teenage driver's insurance is still processing the claim.

In accidents like yours, there is a "primary" payer and a "secondary" payer. If the teenage driver's insurance company is legally responsible for your medical bills, it is the primary payer, and Medicare is the secondary payer. However, if the auto insurer can't or won't pay promptly, Medicare will make conditional payments for your covered medical bills.

If you later receive a settlement or court judgment from the teenage driver's insurer, Medicare would typically be reimbursed for any conditional payments it made in the aftermath of the automobile accident. If you receive a settlement, Medicare is generally reimbursed from those settlement proceeds.

Contact Medicare's Benefits Coordination & Recovery Center (BCRC). Medicare will calculate the amount that must be repaid. You can also call the BCRC toll-free at 1-855-798-2627 or report the accident online using the Medicare Secondary Payor Recovery Portal, providing your full name, Medicare number, date of birth and the accident details.

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Automobile insurance

Given that you don't have collision insurance, your insurance will not pay for the totaled car. Therefore, the teenage driver's insurance company would be responsible for paying for your car, if they are found liable. The state trooper reportedly said the other driver was at fault, but the at-fault drivers' insurer is waiting for the official report before accepting liability.

Assuming the third-party driver's insurance company accepts responsibility, the insurer would normally pay the "actual cash value" of your car if it's declared a total loss. Fair warning: Your car was nearly 20 years old, so any payment will be based on its fair market value before the accident, and not the cost for replacing your car after the accident.

If the other driver's insurer denies liability or disputes the claim, you may have to negotiate with them, file a complaint if appropriate, or even pursue legal action. (Under the circumstances, that may cost you more money than the car was actually worth.) Wait for the other driver's insurance company to complete its investigation and determine liability.

In some states, first-party medical benefits such as Personal Injury Protection (PIP) or Medical Payments (MedPay) coverage may pay before Medicare, but rules vary by state, and not every state requires PIP or MedPay coverage. Some states require PIP with minimums like $5,000 or $10,000. Others require more or have no PIP requirement.

Thankfully, the teenage driver has insurance. If the teenage driver had been uninsured, your collision coverage would not have applied because you don't carry it. Instead, you would have had to rely on any uninsured motorist property damage (UMPD) coverage included in your policy or pursue the driver directly, or pursue the driver for damages.

The at-fault driver does have insurance. That's 99% of the battle.

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-Quentin Fottrell

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08-08-26 1100ET