New Medicare Rule

Medicare continues to make efforts to try, post Haro v. Sebelius, to make for an easier solution for dealing with Medicare liens. The latest? In very small cases, they are more likely to be handled by injury victims themselves as opposed to personal injury lawyers, Medicare will offer a 25% gross payment alternative to dealing with Medicare on a lien.

It is certainly not the deal of a lifetime by any stretch. More importantly, it is only for cases that do not exceed $5,000. But the option applies in:

  • Cases after November 7, 2011
  • Involve physical injury
  • $5,000 or less
  • The option is selected in a to-be-determined time frame
  • Medicare has yet to make a final demand
  • The beneficiary does not expect to receive future third party injury payments

If these conditions are satisfied, a beneficiary will resolve and satisfy Medicare’s lien by paying Medicare 25% of the insurance settlement. While the primary application will now, more than likely, be small soft tissue car accident claims, a successful run might lead to larger scale implementation down the road.


Obviously, locking in gives you some measure of certainty, assuming you know what Medicare paid. The problem is that once you lock in; you lock in. So if the facts change or the victim/lawyer makes the wrong call, there is no turning back.

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