How Can Medicare Affect My Personal Injury Settlement?

Foot and Banana Skin on the Floor

Today, millions of Americans are on medicare. As of 2016, 56.8 million adults benefitted from the program, with now nearly 20 percent of the population covered by it. And that number has grown exponentially in the last 30 years and is only expected to grow even further, with researchers predicting 96.1 million people will be enrolled by 2060. So as this program booms, the millions of individuals accessing it are bound to have questions. 

Like, how much will it cost? Where can I find a quality quote for Medicare insurance? Websites like Easy Medicare help you efficiently get quotes and search for the right Medicare plan for you. 

And other questions might arise too, such as what happens if you are injured while covered by medicare? Medicare might pay the cost of treating the injury. However, things get a bit more tricky if you have a personal injury settlement. Read on to find out how medicare can affect a successful personal injury claim. 

What is medicare?

Firstly, what is medicare and who is it for? Medicare is a federal health insurance program created in 1965 to cover people ages 65 and older. The program was expanded in 1972 to cover certain younger people with long-term disabilities. It helps pay for medical services such as hospital stays, hospice care, prescription drugs and preventive care. Just like how the number of program enrollees has risen, so as the expenditure. In 1970, around $7.5 billion was spent on medicare. As of 2018, this number soared to over $740 billion. 

Medicare and personal injury law

If you have a successful personal injury claim and receive settlement funds, you will be required to repay Medicare for whatever payments it makes for your injury. In order to protect its reimbursement right, Medicare automatically puts a lien on any compensation you receive from Medicare for a personal injury claim. A lien is essentially a legal claim to your property. Unlike private healthcare providers, Medicare does not allow for any negotiation on the lien amount. 

What happens after your settlement?

Once you receive your settlement funds, you must report it to Medicare within 60 days. You can easily do this online at Medicare’s website. Failure to report within two months could result in hefty fines — some reaching $1,000 per day! After reporting the settlement, you should receive a lien within 120 days.

Go over this notice from Medicare with a qualified medical malpractice attorney. Make sure you review it carefully with you lawyer because Medicare is only entitled to reimbursement for treatments and other services associated with your personal injury claim. So make sure the lien doesn’t include expenses from other injuries or illnesses (even if they occurred at the same time as your personal injury claim). 

Next, Medicare will send you a final payment notice to meet within 30 days. You can either pay the lien or file an appeal if you have reason to believe the lien’s amount is incorrect. Now, if any unrelated medical charges were removed from the lien, federal law prohibits Medicare from receiving a lower amount — even if your settlement funds were lower than the lien amount. Basically, the law is meant to ensure Medicare receives the full amount it paid.

Due to this cumbersome process, some individuals might try to hide their settlement funds from Medicare. However, Medicare will most likely find out. The program typically flags payments for any injury that could be related to a personal injury claim. A common example is a broken bone. In that case, you might receive a letter from Medicare asking if the injury was the result of someone else’s negligence. You must answer honestly. Otherwise, you could jeopardize your eligibility to receive Medicare and even lead to a criminal offense.