Medicare and Medicaid


Medicare and Medicaid both provide coverage for accident victims. They also both claim rights to a share of any settlement or verdict you receive in the injury case. Whenever possible, you should use this coverage to pay for accident-related medical bills.

Medicare and Medicaid offices are slow and difficult to deal with. Medicare enjoys very broad rights to control and take money from a personal injury settlement. Further, they will not state and fix their reimbursement claim amount until after a settlement is reached. Thus, the victim will not know his or her net share of any settlement at the time that the gross settlement is reached. We hope to see changes in these difficult laws.

Medicare payments for accident-related medical bills are labeled “conditional payments.” The payment is conditional because it is made without recourse only if you have no other source of payment for the subject medical charge. If the bill that they pay is later paid through the injury claim, Medicare’s position is that they must then be paid back for that charge. At settlement, take time to review their lien claim, force removal of all charges not related to the accident, and negotiate a discount so Medicare takes less from your injury claim payment.

It is sometimes difficult to use Medicare to pay for accident-related medical visits. Medicare’s discounts on doctor bills are growing, and many physicians are turning away new Medicare patients. However, if this is your sole source of health insurance coverage, you should make every effort to use Medicare to pay for all treatment arising from your accident.

Medicaid should not be confused with Medicare. Medicaid often comes into the picture after an accident occurs. Medicaid is need-based health insurance coverage and will be provided only if the patient demonstrates true financial need. Currently, Medicaid recipients cannot have more than $2,000.00 in “spendable resources” in their control at any time. If you are involved in an accident requiring extensive initial hospital care or surgery, your hospital’s account representative may visit with you and discuss an application for Medicaid qualification. If you have no other payment options, it is wise to follow this path and allow the hospital to help you qualify for Medicaid coverage.

Medicaid is administered by state offices, and the current rules limit Medicaid’s total right of payment from your injury claim proceeds. At present, Medicaid cannot take more than 37.5 percent of the total settlement in cases involving attorney representation. This amount can be reduced further through negotiations and also by showing that additional collision-related medical charges remain due at time of settlement.

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