Dealing with a personal injury is challenging enough without the added complexity of navigating Medicare’s involvement in your settlement. If Medicare has paid for any of your medical expenses related to the injury, their right to reimbursement can significantly impact the final amount you receive.
At Ernst Law Group, we’re here to help you navigate this often confusing process so you can focus on your recovery while we handle the legal details. Keep reading to learn more about Medicare and injury settlements, then call our California personal injury lawyers at (805) 541-0300 to schedule your free consultation.
Understanding Medicare and personal injury settlements
Medicare is a federal health insurance program primarily for people aged 65 and older, as well as some younger individuals with disabilities. If Medicare has paid for medical expenses related to your injury, it has the right to be reimbursed from any settlement you receive. This reimbursement obligation can significantly affect how much money you receive from your settlement.
Medicare’s right to reimbursement
Under federal law, Medicare is considered a “secondary payer,” which means it only pays for medical expenses after all other responsible parties have paid. When you receive a personal injury settlement, Medicare must be reimbursed for any medical costs related to your injury. This reimbursement is often referred to as a “Medicare lien.”
Medicare liens in personal injury cases
A Medicare lien is a claim by Medicare to recover the money it has paid for your medical treatment from your personal injury settlement. The Centers for Medicare & Medicaid Services (CMS) enforces these liens, ensuring that Medicare is reimbursed before you can fully access your settlement funds.
How does a Medicare lien work?
When you receive a personal injury settlement, the process typically follows these steps:
- Notification to Medicare – You or your attorney must notify Medicare of your personal injury claim. This allows Medicare to track the medical expenses related to your injury.
- Conditional payment – Medicare makes conditional payments to cover your medical expenses while your personal injury case is pending. These payments are “conditional” because Medicare expects to be reimbursed once you receive a settlement.
- Final demand – After your case is settled, Medicare issues a final demand letter specifying the amount it expects to be reimbursed. This amount is based on the medical expenses Medicare paid on your behalf related to your injury.
- Payment – You are required to reimburse Medicare from your settlement funds. Failure to do so can result in significant penalties, including interest on the amount owed.
Negotiating Medicare liens
It’s possible to negotiate the amount of the Medicare lien. Sometimes, the lien can be reduced if you can demonstrate that the settlement does not fully cover your losses or if there are other mitigating factors. Working with an experienced attorney at Ernst Law Group is crucial in negotiating these liens and ensuring that you keep as much of your settlement as possible.
Impact on settlement amounts
Medicare liens can significantly reduce the money you receive from your personal injury settlement. Because Medicare must be reimbursed before you can access your settlement funds, it’s essential to factor in the lien when negotiating your settlement amount.
Structured settlements and Medicare
If your settlement is structured over time, you’ll need to ensure that Medicare is reimbursed from the portion of the settlement that covers medical expenses. Your attorney can help structure the settlement in a way that complies with Medicare’s requirements while maximizing your available funds.
How Ernst Law Group can help
Navigating the intersection of Medicare and personal injury settlements can be complex. At Ernst Law Group, our experienced attorneys are well-versed in handling Medicare liens and ensuring our clients receive the maximum compensation possible from their settlements. We can help you:
- Notify Medicare – Properly notify Medicare of your injury claim and track all related expenses.
- Negotiate liens – Work to reduce the Medicare lien amount, ensuring you retain more of your settlement.
- Comply with regulations – Ensure full compliance with federal and state regulations to avoid penalties and delays in receiving your settlement funds.
Injured? Call us.
If you’re dealing with a personal injury case involving Medicare, contact Ernst Law Group at (805) 541-0300 for a free consultation. We are here to help you navigate these challenges and protect your rights.
