paying back medicare after settlement
Injured victims who are on Medicare often wonder whether or not Medicare will simply take control of their entire personal injury settlement/judgment. Is it even worth putting in the effort to go through the claims process? The answer is yes, it always worth your time.

Fortunately, if you’re on Medicare, they cannot take your entire recovery. Instead, there is a national formula that Medicare uses that will determine precisely how much you will be paying back Medicare after getting your settlement/judgment. Here, the California personal injury lawyers at GJEL Accident Attorneys discuss some important things that Medicare recipients need to know about personal injury claims and legal rights.

You Must Report Your Claim to Medicare

First and foremost, in the unfortunate event that you end up in a serious accident and that you require medical attention (covered by Medicare), you must report the issue to the appropriate Medicare representative. Indeed, your claim should be reported to the agency within 60 days of the date that you actually received compensation. Your lawyer will be able to make sure that your claim is reported on time, and that all documents and paperwork are completed in the correct manner.

This is critically important because the failure to report your claim could potentially result in you getting hit with major penalties. In the very worst case, you might even end up jeopardizing your Medicare eligibility. Further, you could also be subject to fines against your eventual recovery. In fact, Medicare could even potentially charge you a fine of $1,000 per day for each day that you fail to report your claim.

The Medicare Personal Injury Claims Formula

Under federal regulations, the most that Medicare should ever take is 50 percent of the net payment to you. For example, imagine that you have a medical bill paid by Medicare of $300,000. After going through the legal process, you are able to recover $100,000. In this circumstance, Medicare can only take one half of the net recovery for you. Net recovery versus total recovery is a very important distinction to make in these cases. This is because your claim will be adjusted for the legal fees that will be taken out of your settlement offer or injury verdict. In the above example, assume that your attorney charges a third or $33,333. That would leave $66,667 left for your recovery. Medicare would be limited, by law, to taking only $33,333.50 of this amount, while the remaining $33,333.50 would go to you, tax free.

Reimbursing Medicare and Filing an Appeal

To know exactly how much you owe Medicare in reimbursement, you should wait for Medicare to send you an official notification. You should receive this letter within 120 days of the date that you reported your claim. Of course, by this time, your lawyer should already have made their own determination of how much you will owe. This will allow you to be fully prepared to handle the issue. If the Medicare office disagrees with your lawyer’s position, which is unusual, but is not entirely rare, then you can seek an appeal. Your lawyer will be able to help you fight for the full amount of compensation that you are owed.

Get Legal Help Now

Our attorneys have extensive experience dealing with Medicare, their contractors and the internal reimbursement appeals process. If you are a Medicare recipient and you were seriously hurt in an accident in the Bay Area, let our team help you maximize your recovery. Please do not hesitate to call us today at 1-855-508-9565 to set up a free, no-pressure review of your claim.


Andy Gillin received his Bachelor’s Degree from the University of California at Berkeley and his law degree from the University of Chicago. He is the managing partner of GJEL Accident Attorneys and has written and lectured in the field of plaintiffs’ personal injury law for numerous organizations. Andy is a highly recognized wrongful death lawyer in California.