Medicare Basics in Personal Injury Cases

Medicare Eligibility

• Medicare is primarily available to individuals aged 65 and older, as well as certain younger people with disabilities.

Medicare Parts

• Part A of Medicare covers hospital insurance.

Medicare's Role in Personal Injury Cases

• Medicare acts as a secondary payer when other insurance is involved in personal injury cases.

Medicare Conditional Payments

• Medicare conditional payments are made when the primary payer is not expected to pay promptly.
• These payments are made to cover injury-related expenses.

Reimbursing Medicare Conditional Payments

• When a primary payer settles, Medicare's conditional payments must be reimbursed to Medicare.

Medicare Lien

• A Medicare lien is a legal claim by Medicare to recover payments it made for injury-related care.

Medicare Set-Aside (MSA) Arrangement

• The purpose of an MSA arrangement is to set aside a portion of a settlement for future medical expenses related to the injury.

Reporting Settlements to Medicare

• Insurers and self-insurers must report settlements, judgments, awards, or other payments to Medicare.

Consequences of Non-Compliance

• Failure to comply with mandatory reporting to Medicare can result in significant fines and penalties.

Importance of Record-Keeping

• It is crucial to keep detailed records of medical treatments and expenses related to the injury to ensure accurate calculation of Medicare's recovery amount.

Learn about Medicare's eligibility requirements, its various parts, and its role in personal injury cases, including conditional payments.