Can Medicare Take My Settlement?

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If you use Medicare for health insurance coverage and get into a personal injury accident, the claims process may look different for you than other claimants. Medicare provides coverage for policyholder injuries in the event of an accident. The system expects payback, however, if you obtain a settlement or verdict as part of a personal injury award. Therefore, Medicare can take your settlement. Be aware of the facts of your policy and rights in case of an accident.

How Does Medicare Work After an Accident?

Medicare is a federal health insurance program for the elderly and certain younger people with disabilities or health problems. It provides benefits if policyholders get into accidents and require medical treatment. To receive your Medicare benefits after something like a car accident, slip and fall, or act of violence, you must report your accident and injuries right away. Federal law requires you to contact the Medicare Coordination of Benefits (COB) Contractor and report your accident.

The COB is a private company responsible for processing and distributing Medicare benefits, as well as for reimbursing Medicare after a policyholder recovers compensation through a personal injury claim. Find the contact information for your COB in your Medicare policy paperwork, or through the Centers for Medicare & Medicaid Services (CMS) website. The COB agent will request descriptions of your accident and injuries, as well as the names of your doctor and your lawyer, if you’ve hired one to represent your injury case.

Failing to report your accident to the COB contractor could jeopardize your eligibility for Medicare benefits. Once you file your report, an agent from Medicare will take over your case and monitor its progress. The contractor may periodically contact you (or your lawyer) for updates as your personal injury claim commences. You must comply with these requests for information if you wish to obtain Medicare benefits.

How Will Medicare Take What You Owe From a Settlement?

Once you and your accident lawyer successfully settle your lawsuit or resolve a personal injury trial, you will notify the COB contractor of the award you received for your damages. If you hired a lawyer, it is his/her duty to notify the contractor of a successful outcome before distributing any funds from a settlement or judgment to you. The contractor will then send you or your attorney a statement of all the bills Medicare paid on your behalf.

You and your attorney will review the charges from Medicare to check that everything is correct. The contractor will include all charges he/she thinks relate to your case. Occasionally, COB contractors make mistakes and charge claimants for medical treatments that didn’t have anything to do with the accident or that never happened. Entrust your documents to a lawyer to carefully review the invoice before you repay Medicare for its benefits.

If you agree with the charges, your lawyer will send the COB contractor a check reimbursing Medicare for the exact amount it gave you to cover your medical treatment. This money will come directly from your settlement or judgment award. You will receive any remaining amount (minus any lawyer or court fees you owe) after Medicare gets its cut. You cannot negotiate with the amount you owe Medicare, except in very rare cases. Your lawyer can help you understand whether a negotiation is possible.

Don’t Agree With the Medicare Charges? File an Appeal

If you or your attorney find something amiss on the invoice, you have the option to file an appeal against the contractor’s determination. The appeals process will interfere with your ability to obtain the full amount of your settlement until it ends. The money will go into escrow or go to the COB contractor depending on the situation. You can, however, receive the amount you would normally have access to after paying Medicare what you owe. Using a lawyer to help with the claims process and your Medicare bills can make it easier on you after a personal injury accident.