“Medical bills are the number one cause of bankruptcy in the U.S.”, a sobering statistic from the American Journal of Public Health. If you’ve been in a car accident, those bills can pile up fast. Ambulance rides. ER visits. Follow-ups. Physical therapy. It adds up before you even realize it.
You’re left wondering – does health insurance cover car accident injuries? And if so, how much? Who pays first? What about Medicaid or accident insurance?
Let’s make sense of it all.
Will My Health Insurance Cover Car Accident Injuries?
Yes, your health insurance can pay for injuries from a car accident, but it may not be the first in line to pay.
Health insurance is a payer of last resort in many situations involving a car crash. That means if there’s another insurance policy that should pay first, like auto insurance, your health insurer might wait to pay or cover only what’s left over.
Still, your health plan will usually step in to cover your medical costs when:
- You don’t have medical payments (MedPay) or personal injury protection (PIP) through your auto policy.
- You live in a state where PIP isn’t required.
- Your MedPay or PIP limits have been exhausted.
- You were hit as a pedestrian or cyclist, and no auto insurance applies.
Your health insurance may cover:
- ER visits
- Hospital stays
- X-rays and MRIs
- Surgery
- Physical therapy
- Prescription drugs
- Follow-up doctor appointments
Example: You’re in a crash, and the at-fault driver’s insurance is slow to respond. In the meantime, your health insurance covers your treatment. Later, your health insurer may be reimbursed when you settle the claim (see Subrogation below).
What About Out-of-Pocket Costs?
You’re still responsible for your deductible, copays, and coinsurance, unless another policy covers them or you’re later reimbursed. These out-of-pocket costs can add up quickly. That’s why many people choose to carry MedPay or accident insurance to help cover the gaps in coverage (we’ll explain how those policies work next).
Does Medicaid Cover Car Accident Injuries?
If you’re on Medicaid, the answer is yes, with caveats.
Medicaid does cover car accident injuries, but it usually pays only after other coverage (like auto insurance or liability insurance) has been used up.
Medicaid rules differ by state, but some common factors include:
- State-specific rules about what Medicaid will pay and when.
- Mandatory reporting: You may have to tell Medicaid if someone else could be liable for your injuries.
- Reimbursement rules: Medicaid has the legal right to recover its costs from any settlement or judgment.
Important: If you settle a car accident claim without accounting for Medicaid’s right to reimbursement, you could be on the hook to repay benefits you received.
If you’re unsure how Medicaid applies in your situation, an attorney from The Roth Firm can help review your claim and protect your benefits.
How Does Accident Insurance Work with Health Insurance?
Accident insurance is a supplemental policy. It doesn’t replace health insurance, it works alongside it.
Here’s how it works:
- If you’re injured in an accident, you file a claim with your accident insurance company.
- You receive a lump sum or fixed payments based on your injuries or services (e.g., $1,000 for a broken leg, $500 for an ER visit).
- You can use the payout for anything—deductibles, copays, lost wages, or even household expenses.”
Key difference: Health insurance pays providers directly, based on the treatment you receive. Accident insurance pays you, based on the type of injury or event.
Why It Matters
Your health insurance car accident coverage might leave you with thousands in out-of-pocket costs. Accident insurance can fill that gap, especially if you have a high-deductible plan or limited savings.
Some employers offer accident policies through workplace benefits, or you can purchase one individually.
Subrogation
This is where things get tricky.
Subrogation is your health insurance company’s right to seek reimbursement for medical bills it paid if someone else is found responsible for your injuries.
Example: You’re injured in a crash. Your health insurance pays $20,000 in hospital bills. Later, you win a $100,000 settlement from the at-fault driver. Your health insurer might demand repayment of the $20,000 it paid on your behalf.
They don’t always get the full amount back, but they usually get something.
Why It Matters To You
If you receive a settlement or court award, you might not be able to keep all of it. A portion may need to go back to your insurer under subrogation rights.
This is where legal guidance becomes critical. Attorneys at The Roth Firm help clients negotiate with insurers, reduce subrogation claims, and protect their final recovery.
Coordination of Benefits
When more than one insurance plan could cover your injuries, coordination of benefits (COB) rules decide who pays first.
For car accidents, here’s how COB typically works:
- Auto insurance (PIP or MedPay) pays first.
- Then, health insurance pays remaining covered expenses.
- If there’s another person at fault, their liability insurance might reimburse you or your health plan later.
Practical Example
You live in Georgia and carry $5,000 in MedPay coverage. You’re in a wreck and rack up $15,000 in hospital bills.
- Your MedPay pays the first $5,000.
- Your health insurance pays the next $10,000 (subject to deductibles and copays).
- You later sue the at-fault driver and settle for $50,000.
- Your health insurer may claim part of that under subrogation.
Having an attorney involved early helps you manage COB issues before they complicate your case.
Final Thoughts
Auto accidents raise more than just health concerns, they raise financial questions most people aren’t ready to answer on the spot. Your health insurance can cover car accident injuries, but it’s not always the first in line to pay, and it often comes with strings like subrogation.
Medicaid covers accident-related care too, but with tighter reimbursement rules. Accident insurance can help bridge the gap between treatment and out-of-pocket expenses. And when multiple policies apply, coordination of benefits decides who pays what.
If you’re injured in a car accident, don’t try to juggle insurance paperwork and legal nuances alone.
Contact The Roth Firm today for a free consultation. We’ll review your case, deal with the insurance companies, and fight for every dollar you’re owed, so you can focus on healing.