How Medicare and Medicaid Impact Personal Injury Claims

Posted on behalf of Rizk Law on Feb 12, 2014 in Insurance Issues

When you are on Medicare or Medicaid, getting a personal injury settlement can look a little different than if you have private-pay insurance. It’s something known as the Medicare Secondary Payer process, which means that when you win a settlement for an injury, you become the primary payer and Medicare becomes the secondary payer. Federal law mandates that if you get reimbursed for injuries that you then reimburse Medicare for your medical bills.

In the past, Medicare or Medicaid would give you an estimate, and then when your case was completed, Medicare would send you a final bill. Unfortunately in many cases, huge discrepancies emerged between the amount of the initial quote and the final bill. This meant that sometimes those who were awarded settlements weren’t able to access their money for a year or more, until Medicare submitted it’s final tally.

A new law took effect at the beginning of 2013 to help individuals access that money faster, and with more transparency in the billing system. The Strengthening Medicare and Repaying Taxpayers Act created a web portal for litigants and set deadlines for Medicare to pass on information.

The new law requires:

  • Medicare to post payments made to medical providers within 15 days of payment
  • Requires beneficiaries to notify Medicare within 120 days of a settlement
  • Medicare has 11 days to respond if a beneficiary disputes what Medicare says it is owed
  • Limits Medicare payments to three years from settlement date

These new rules will help those whoa re expecting settlement payments to know what to expect, but you will still need to stay on top of the system and communicate with Medicare about your claim.

If you questions about Medicare or Medicare and a possible personal injury claim, contact Portland personal injury attorney Richard Rizk by emailing calling 503.245.5677, or visiting