Will You Lose Your Medicare Coverage When You Settle Your Personal Injury Case?

Many people who are seriously injured in an accident that was not their fault must rely on Medicare to pay for some or all of their medical bills, especially those that are incurred soon after the accident. You might have relied on Medicare assistance, too, after your accident. While Medicare helps you use necessary medical treatments without falling into dire financial straits, you can work on a personal injury claim to file against the party that caused your injury. But if that same claim is settled, what happens to your Medicare benefits? Do they end?

The Medicare Secondary Payer Act, which is a federal law applicable to all 50 states, requires that Medicare only pay medical bills that no one else is responsible to cover. If you settle a case in which you made a claim for future medical treatment, Medicare will take the position that you now must pay for the future medical treatment out of your settlement and then refuse to pay.

Do Workers’ Compensation Exceptions Apply?

Medicare has created guidelines for settlements in workers' compensation cases that will protect a claimant’s Medicare coverage after the settlement of their case. Medicare has not yet done this for third-party liability settlements, but it is reasonable to believe that following Medicare’s guidelines for workers' compensation cases will protect a claimant in a personal injury liability claim, too. The guidelines can be found online in a document from Centers for Medicare & Medicaid Services (CMS) titled Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide May 11, 2020. [Click here to load a PDF file from the official CMS website.]

In worker’s compensation cases, Medicare provides for the creation of a Medicare Set-Aside (MSA). First, you need to determine what the cost of your future medical treatment will be. You can hire a company like MEDVAL or Synergy Settlement Services to prepare a Medicare Set-Aside allocation. Next, you need to take the money allocated for your future medical treatment out of your settlement and place it into a Medicare Set-Aside (MSA) account. You can manage this Medicare Set-Aside (MSA) yourself by following Medicare’s guidelines or hire a company to manage it for you. You will pay your injury-related medical bills from your MSA account. If your MSA account is eventually exhausted Medicare will begin to pay the bills again. Companies like Synergy Settlement Services are experts in Medicare compliance, so they are often among the first names recommended to injury claimants who are also relying on Medicare coverage.

When in Doubt, Ask an Attorney

Paying for future injury-related care, otherwise covered by Medicare, out of a personal injury settlement is a developing area of the law with frequent twists and turns. It is important that you consult an attorney for the most up to date requirements and the best way to protect your Medicare coverage.

If you live in Laurel, Maryland, or the surrounding area, McGowan & Cecil, LLC and our personal injury attorneys can help you throughout your personal injury case. We are highly familiar with both liability law and Medicare coverage complications, so we are confident we can walk you through your case, regardless of its complexity. Our professional network of industry experts also lets us connect with companies that can assist with your Medicare Set-Aside and more.

Dial (301) 761-2007 to speak with a member of our law firm today about your case.


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