Does Medicare Affect Personal Injury Settlements in NYC? What You Need to Know
If you are a Medicare recipient injured in an accident in New York City, you may be asking: “Does Medicare affect my personal injury settlement?” The answer is yes.
Medicare has a legal right to reimbursement for accident-related medical expenses it paid, and this repayment – called a Medicare lien – can significantly reduce the amount of money you take home.
At Greenstein & Pittari, LLP, our NYC personal injury lawyers understand how Medicare liens work and how to protect your recovery.
We help clients resolve Medicare’s claims, dispute unrelated charges, and negotiate reductions so you keep as much of your settlement as possible.
Why Medicare Affects NYC Personal Injury Settlements
Under the Medicare Secondary Payer (MSP) Act, Medicare is considered a secondary payer. This means:
- If a negligent party in NYC (such as a car accident driver, landlord, or business) is responsible for your injuries, their insurer should pay for your treatment.
- Medicare liens also apply to medical malpractice and nursing home neglect cases in NYC.
- However, Medicare often pays your medical bills up front to avoid delays in care.
- These payments create a lien that must be reimbursed once you receive a settlement or court award.
If Medicare’s lien is not properly resolved, you risk:
- Owing double damages and interest
- Federal collection actions
- Issues with your future Medicare coverage
What Medicare Can and Cannot Recover
| ✓ Medicare CAN Recover | ✗ Medicare CANNOT Recover |
|---|---|
| • Emergency room visits • Hospital stays • Surgeries and procedures • Rehabilitation and physical therapy • Prescription medications • Doctor visits related to the injury • Medical equipment and supplies • Diagnostic tests (X-rays, MRIs, etc.) |
• Pain and suffering compensation • Lost income or wages • Reduced earning capacity • Emotional distress damages • Loss of enjoyment of life • Punitive damages • Loss of consortium • Future non-medical losses |
The Medicare Lien Process in NYC
Here’s how Medicare’s claim typically works in a New York City personal injury case:
- Notification – Your lawyer reports your claim to the Benefits Coordination and Recovery Center (BCRC).
- Conditional Payment Letter (CPL) – Medicare sends a list of medical charges it believes are related to your accident.
- Disputes – Your attorney may challenge unrelated or excessive charges.
- Final Demand Letter – Medicare issues the official repayment amount after settlement. Payment is due within 30 days.
- Repayment – The lien is paid directly from your settlement before funds are released to you.
| Stage | Action | Deadline |
|---|---|---|
| Step 1 | Your lawyer reports the claim to BCRC | At case initiation |
| Step 2 | Medicare sends a Conditional Payment Letter (CPL) | Within 60-90 days of notification |
| Step 3 | Attorney disputes unrelated/excessive charges | Before settlement finalization |
| Step 4 | Medicare issues Final Demand Letter | After the settlement notification |
| Step 5 | Report settlement to Medicare | Within 60 days of settlement |
| Step 6 | Repay the Medicare lien | Within 30 days of Final Demand |
How Much of Your Settlement Can Medicare Take?
Medicare’s lien is limited to the actual amount it paid for accident-related care in NYC, such as:
- Emergency room visits and hospital stays
- Surgeries and rehabilitation
- Prescription medications
Medicare cannot recover from compensation for:
- Pain and suffering
- Lost income or reduced earning capacity
- Emotional distress or loss of enjoyment of life
Can Medicare Liens Be Reduced?
Yes. There are several ways to reduce what Medicare collects in a New York personal injury settlement:
- Disputing specific charges as unrelated to the injury
- Applying a statutory reduction for attorney fees and litigation costs
- Hardship or Compromise Requests – In certain NYC cases, Medicare may agree to reduce its lien if repayment would leave you with little or no recovery.
Medicare vs. Medicaid in NYC Settlements
| Factor | Medicare | Medicaid |
|---|---|---|
| Program Type | Federal entitlement program | State needs-based program |
| Lien Rights | Yes – must be repaid from the settlement | Yes – must be repaid from the settlement |
| Settlement Impact on Eligibility | No – coverage continues regardless | Yes – may affect eligibility (use special needs trust) |
| Negotiation Possible | Yes – can dispute charges and request reductions | Yes – but rules vary by state |
| Enforcement Period | 3 years from notice of settlement | Varies by state |
Statute of Limitations on Medicare Enforcement
Medicare has three years from notice of your NYC settlement to enforce repayment. After that, it cannot pursue collection.
Example Medicare Lien Scenarios in NYC
- Example 1: You settle a Manhattan car accident case for $100,000. Medicare paid $15,000. Its lien is $15,000, leaving you with the balance after fees.
- Example 2: You settle a Brooklyn slip-and-fall claim for $30,000. Medicare claims $10,000, but your attorney disputes unrelated charges and negotiates it down to $5,000, increasing your recovery.
Frequently Asked Questions About Medicare Liens in NYC
Get clear answers about Medicare reimbursement rights.
Will I lose my Medicare coverage if I settle?
No. Medicare is an entitlement program, not needs-based.
Your coverage continues, but Medicare must be reimbursed for accident-related care it already paid.
How much will Medicare take from my settlement?
It depends on your accident-related bills. Liens may range from hundreds to tens of thousands of dollars.
A skilled NYC lawyer can often negotiate reductions.
What happens if I don’t repay Medicare?
You could face double damages, interest, and federal collection actions.
Your future Medicare benefits may also be at risk.
What is a Medicare Set-Aside (MSA)?
An account created with part of your settlement to cover future medical expenses related to your injuries.
MSAs protect your Medicare benefits and ensure compliance with federal law.
Why do I need a lawyer?
Medicare’s rules are complicated. An experienced NYC personal injury attorney can ensure compliance, negotiate with Medicare, and safeguard your financial recovery.
Why Choose Greenstein & Pittari, LLP for Medicare Lien Cases in NYC
At Greenstein & Pittari, LLP, our New York City personal injury lawyers:
- Notify and communicate with Medicare to prevent penalties
- Dispute unrelated or excessive charges
- Negotiate lien reductions and hardship requests
- Advice on Medicare Set-Asides for future care
- Protect your financial recovery while keeping your benefits intact
Speak With a Top New York City Personal Injury Lawyer in New York City Today
If you were injured in New York City and Medicare paid for your medical care, don’t risk losing more of your settlement than necessary.
At Greenstein & Pittari, LLP, we fight to maximize your recovery while ensuring compliance with federal law. Call 1-800-VICTIM2 (1-800-842-8462) for a free consultation today.
We proudly represent clients in Manhattan, Brooklyn, Queens, the Bronx, Staten Island, and Yonkers.
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