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  • Writer's pictureTom Fowler

How Much Will Medicare Take from My Settlement?

A statute involving the Medicare lien requires anyone interested in transferring money to resolve or settle any outstanding personal injury debt. These programs also aim to provide qualified people with medical benefits.

These fees need to be paid for the Federal Medical program to continue providing benefits to its members. It needs to be proven that a negligent third party caused the accident for the scheme to pay for medical care.

What Are Medicare and Medicaid?

What Are Medicare and Medicaid?

These are government-funded programs that provide medical benefits to qualified individuals. Medicaid is state-run, while Medicare is a Federal program. Both pay out benefits for past personal injury medical expenses that arose. It is attached to a statutory lien which helps cover the cost involved in medical procedures.

However, Medicare is unlike Medicaid. It is required by federal laws that money is set aside to cover the cost of any anticipated future medical bills.

Is Repayment of a Past Medical Lien Required?

Anytime Medicaid or Medicare has paid for medical benefits. There is an obligation on both the attorney and client to repay the fees. Of course, the money needs to be recovered from a negligent third party to pay back any expenses.

It is imperative to note that there is no difference between what the settlement money was paid for. An example of this is pain and suffering vs. medical bills. The entire settlement is on the line and the person should protect the settlement.

If they fail to repay Medicare, the government can sue the lawyers for interest plus double damages. That is due to the lawyer knowingly ignoring the lien. The Medicaid lien laws vary in different states, be sure the state can sue the lawyer and client for the interest plus the lien amount.

A requirement from Medicare is that a form is completed and notify them on every personal injury case to check for unpaid medical bills. Any prudent auto accident attorney Des Moines provides handling a case must confirm steps and consider any Medicare liens.

Medicare and Medicaid Reimbursement Rates

Medicaid and Medicare have extensive bargaining power with medical doctors.

Huge discounts can be negotiated for the services received by their clients. That is possible due to the volume of patients covered. It is essentially a mass volume discount that helps them create revenue.

If an individual might get charged $10,000 for the medical procedure, the Medicare reimbursement rate might only be $500. That means the other $9,500 gets written off by the scheme.

It is important to note that the jury may not be told the discount medical bill price under Iowa law. The medical expense often influences how the jury or judge awards for pain and suffering. If they hear that medical damages were only $500, they are more likely to award commensurate damages to the value of $500. That can be detrimental to a person expecting the $10,000 in medical to be paid out.

A personal injury lawyer from Tom Fowler Law can help to bring the claim to court. They can also assist in determining the compensation owed. Unfortunately cost prohibition can occur for legitimate claims because people can easily spend $5,000 to bring the case to court.

What Is Medicare Set-Aside?

Setting up Medicare Set-Aside is not easy or free. Generally, individuals need all medical records reviewed by a qualified professional. They need to approximate the cost and decide on a reasonable amount to set aside. Some companies specialize in this. Most companies charge between $3,000 to $5,0000 to manage this service. In a more complex case, it is much higher.

These extra costs need to be factored in to see if the case is profitable enough to handle. One of Tom Fowler Law’s attorneys can help calculate any additional fees.


Anytime Medicare pays for medical bills that arise from a serious injury case, like whiplash, it has multiple negative impacts on the issue. A lien is created to reimbursed Medicare for past hospital expenses. It could reduce the anticipated pain and suffering compensation and lower the amount claimed as damages.

Contacting Tom Fowler Law is the best thing to do when a person suffers a personal injury due to a third party's negligence. Let them help to retrieve fair compensation while dealing with Medicare during an injury claim.


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