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Medicare Patients Must Pay Up in Personal Injury Cases

Posted on in Personal Injury

Medicare Patients Must Pay Up in Personal Injury CasesSenior citizens and adults with certain disabilities rely on Medicare to pay for their medical expenses. This health insurance coverage is particularly helpful if you have suffered an accident that resulted in a personal injury. As with any accident victim, you have the right to file a lawsuit seeking compensation from the party at fault. However, Medicare patients who are awarded damages from personal injury cases must repay Medicare for medical expenses related to the injuries. You risk financial or criminal punishment if you do not comply with Medicare’s requirements:

  1. Reporting Your Incident: You are expected to report any accident involving injury to the Medical Coordination of Benefits Contractor. If you do not report your injury, Medicare officials still have ways to monitor your medical expenses and will reach out to you if they see any doctor visits that suggest an injury. You must answer truthfully when Medicare officially asks you for details about your injury and its cause.
  2. Reporting Your Injury Compensation: Medicare also must know when you have received injury compensation as result of a settlement or verdict. Medicare has the right to retrieve compensation from your injury award before you collect on it.
  3. Reviewing the Medicare Lien: Medicare will give you notice of a lien it has placed on your injury compensation. You must compare the lien amount to the Medicare expenses related to your injury, looking for any listed expenses that may be unrelated. The lien may need to account for future medical expenses related to your injury.
  4. Paying or Appealing the Lien: After receiving the final lien, you may appeal the total if you believe it is inaccurate. Otherwise, you will likely have to repay the full amount. Federal law does not allow Medicare to negotiate a lower lien with a patient, except in rare circumstances. 

Cost Variables

It is possible for Medicare to claim the entire value of your injury compensation before you have a chance to collect it. The lien is dependent upon the cost to Medicare, not the amount you receive in your case. However, there are factors that can reduce or limit the amount that Medicare can claim:

  • Medicare has a formula that reduces its lien amount to account for attorney fees; and
  • There is a fixed percentage when awards and settlements are $5,000 or less.

Anticipating Medicare Claims 

Because part of your injury compensation will go to Medicare, it is important that you receive an award or settlement that covers all of your medical costs and any pain and suffering. A McHenry County personal injury attorney at Botto Gilbert Lancaster, PC, can help you obtain the compensation amount you need. Schedule a free consultation by calling 815-338-3838.



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