Ok I missed the “fall” part, so this was a personal injury settlement. Please please pls if you are on MediCARE to check to see if in the settlement paperwork that the MSA / Medicare Set Aside was done. For your sake, I hope that it was.
Here’s why it’s mucho importante…. - Medicare (via CMS) has a system to identify claims that would fit the pattern of care for those who are hospitalized or have care done stemming from an accident. If codes for service fit, then the billing records for them are pulled and reviewed. If these show care was due to an accident then state database is searched to see if a lawsuit was filed (a personal injury or tort claim) and what settlement was paid. - usually in personal injury lawsuits all costs of care from doctor visits to hospital stay to rehab stuff are all included in the lawsuit along with your pain&suffering costs and the atty fees and court costs. Done as it really hikes up the # for the lawsuit. - So say medical costs ended up being $ 87,654 of which MediCARE paid $67,890 and the atty filed a lawsuit for 150K of which atty fees & court costs were 18K - Attorneys do a negotiated settlement for 100K & get paid their 18. So you are left with $ 72K. - Medicare does not, DOES NOT, ever accept the terms of a negotiated settlement. If Medicare paid $67,890, Medicare fully expects the reimbursement of $67,890 back. You end up with just $ 6,069.00. This is why it’s beyond important that a MSA escrow like account is set up for PI settlements. If it ended up being negative to you, MediCARE does not care, the full amount of money is due back to Medicare. - if it didn’t happen, you need to contact Medicare and set up a payment plan & asap as Medicare can place a fine for noncompliance. - MSA requirements are federal law from DRA2005 redo on Medicare & Medicaid regulations. But kinda only been since 2015 that MediCARE started going after reimbursement & it’s now done routinely.
The ultimate responsibility on this is with the person on Medicare. It is not on the atty to ensure or do the MSA.
Medicare like the IRS is a super creditor. So they can seek payment from your Social Security income or tax refunds. Really you don’t want to go there…. you want to work out a repayment with Medicare.
Hopefully your PI atty did the MSA, so you do not have this worry.
Was this a personal injury (tort) settlement? If so I’d be also worried abt Medicare. Medicaid matters if the $ changes your income and assets and it takes you over the limit allowed by your state for whatever Medicaid program you are on. BUT If you were on MediCARE and if you had some sort of accident - like an auto accident or a slip n’fall - then did a personal injury lawsuit against someone and then got a settlement AND there was any hospitalization, rehab or other health care due to the accident and MediCARE paid any costs, MediCARE fully expects for all costs they paid to be repaid at 100% to them from the settlement. And Medicare has ways to ensure they get repaid…. It will not be friendly.
if you had a better tort attorney, they would have done a MSA aka a Medicare Set Aside account. MSA $ from the settlement - less attorneys and court fees - is placed in an escrow like account. How this gets sticky is Medicare does not accept whatever $ amount an atty might do in a negotiated settlement. Medicare expects full freight reimbursement for costs paid. Because of that and then having to deal with the payment of the MSA $, I’ve found better law firms will not do PI work unless it’s a ton of $ anticipated and that tends to mean there’s someone killed or maimed bad and has dependents… so there’s gonna be a big settlement, $M+. For the smaller potential lawsuits, those go to smaller law practice and they may not do the MSA. It’s ultimately the responsibility of person on Medicare to have Medicare reimbursed in full. If this wasn’t done, MediCARE has to be contacted to see how to now reimburse them. You may end up with not much $ left if the attorney did reductions to the settlement Agreement.
Are you currently on Medicaid? If so this settlement is reportable as an asset for you. And yes, Medicaid will stop until you have spent down, if you are currently receiving it. And this settlement goes for your care until it is spent down.
3 Answers
Helpful Newest
First Oldest
First
Here’s why it’s mucho importante….
- Medicare (via CMS) has a system to identify claims that would fit the pattern of care for those who are hospitalized or have care done stemming from an accident. If codes for service fit, then the billing records for them are pulled and reviewed. If these show care was due to an accident then state database is searched to see if a lawsuit was filed (a personal injury or tort claim) and what settlement was paid.
- usually in personal injury lawsuits all costs of care from doctor visits to hospital stay to rehab stuff are all included in the lawsuit along with your pain&suffering costs and the atty fees and court costs. Done as it really hikes up the # for the lawsuit.
- So say medical costs ended up being $ 87,654 of which MediCARE paid $67,890 and the atty filed a lawsuit for 150K of which atty fees & court costs were 18K
- Attorneys do a negotiated settlement for 100K & get paid their 18. So you are left with $ 72K.
- Medicare does not, DOES NOT, ever accept the terms of a negotiated settlement. If Medicare paid $67,890, Medicare fully expects the reimbursement of $67,890 back. You end up with just $ 6,069.00. This is why it’s beyond important that a MSA escrow like account is set up for PI settlements. If it ended up being negative to you, MediCARE does not care, the full amount of money is due back to Medicare.
- if it didn’t happen, you need to contact Medicare and set up a payment plan & asap as Medicare can place a fine for noncompliance.
- MSA requirements are federal law from DRA2005 redo on Medicare & Medicaid regulations. But kinda only been since 2015 that MediCARE started going after reimbursement & it’s now done routinely.
The ultimate responsibility on this is with the person on Medicare. It is not on the atty to ensure or do the MSA.
Medicare like the IRS is a super creditor. So they can seek payment from your Social Security income or tax refunds. Really you don’t want to go there…. you want to work out a repayment with Medicare.
Hopefully your PI atty did the MSA, so you do not have this worry.
-
If so I’d be also worried abt Medicare.
Medicaid matters if the $ changes your income and assets and it takes you over the limit allowed by your state for whatever Medicaid program you are on.
BUT
If you were on MediCARE and if you had some sort of accident - like an auto accident or a slip n’fall - then did a personal injury lawsuit against someone and then got a settlement AND there was any hospitalization, rehab or other health care due to the accident and MediCARE paid any costs, MediCARE fully expects for all costs they paid to be repaid at 100% to them from the settlement. And Medicare has ways to ensure they get repaid…. It will not be friendly.
if you had a better tort attorney, they would have done a MSA aka a Medicare Set Aside account. MSA $ from the settlement - less attorneys and court fees - is placed in an escrow like account. How this gets sticky is Medicare does not accept whatever $ amount an atty might do in a negotiated settlement. Medicare expects full freight reimbursement for costs paid. Because of that and then having to deal with the payment of the MSA $, I’ve found better law firms will not do PI work unless it’s a ton of $ anticipated and that tends to mean there’s someone killed or maimed bad and has dependents… so there’s gonna be a big settlement, $M+. For the smaller potential lawsuits, those go to smaller law practice and they may not do the MSA. It’s ultimately the responsibility of person on Medicare to have Medicare reimbursed in full. If this wasn’t done, MediCARE has to be contacted to see how to now reimburse them. You may end up with not much $ left if the attorney did reductions to the settlement Agreement.
ADVERTISEMENT