Visitor Question

Do I have to repay Medicare from my injury settlement?

Submitted By: Anonymous (Green Valley, Arizona)

I fell in a store after tripping over a pallet that was left near the aisle (mostly empty of merchandise). The store manager filed a report with their insurance company.

I sustained multiple deep bruises on my thigh, femur and foot. I saw a doctor the following Monday and was referred for an x-ray of my femur and later an ultrasound to check for blood clots. There were no breaks or clots, but the bruises and soreness continued for several weeks.

I was contacted by their adjuster, and after several phone conversations and e-mails I was offered a settlement of $750 to cover any out-of-pocket co-pays and for “pain and suffering.”

However, the waiver I was sent to sign notes that since I have a Medicare plan, I agree to repay any expenses my insurance paid. I declined to sign it without knowing the amount, but was told Medicare would not pursue payment under $750.

I am uncomfortable with this and don’t know how to proceed.  Should I assume I’ll have to repay Medicare out of my settlement from the insurance company? Thank you for some direction on this.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Anonymous,

You ask an important question about what can be a confusing and frustrating issue.

As you know, Medicare is essentially a health insurance program funded and administered by the federal government that is best known for providing coverage to people who are 65 years of age or older.

Medicare is considered a secondary payor to all types of liability insurance. What that means is that if Medicare pays your medical bills due to an injury and you later recover money for that injury from another party, you may have to reimburse Medicare some portion of your recovery.

In November 2016, the Centers for Medicare and Medicaid Services (CMS) established a reporting threshold of $750 related to Medicare’s recovery claim.

In regular language, this means that if you receive a liability settlement for a physical injury of $750 or less you do not need to report that settlement to Medicare and you will not need to repay any of that amount to Medicare.

CMS reviews that reporting threshold every year, and it remains at $750 or less for 2020.

Settlements Higher Than $750

Please note, however, that if you were to negotiate a settlement in excess of $750, Medicare’s right to repayment the portion of your settlement amount could kick in.

Medicare has a Fixed Percentage Option that allows a person to repay a flat 25% of their recovery for settlements up to $5,000. You can find out more about the Fixed Percentage Option through the Medicare Secondary Payer Recovery Portal  and this Fixed Percentage Option Brochure.

Keep your potential repayment obligations in mind if you attempt to negotiate a higher settlement amount with the store’s insurance company.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.

 

Learn more here: Liens on Your Injury Settlement

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.

Find a local attorney to give you a free case review here, or call 888-972-0892.

We wish you the best with your claim,

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