Medicare Advantage Plan Liens

Medicare Advantage Plan Liens

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

The MA Plan provides all of Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. MA Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Medicare pays a fixed amount for your care every month to the companies offering MA Plans. These companies must follow rules set by Medicare.

Medicare Advantage Glossary

Resolution

The process of notifying, verifying, and negotiating a lien until final resolution is reached. This may include the pursuit of compromises, appeals or waivers until the lien holder produces their final offer for recovery.

Verification

The process of determining if an insurer has a lien (an affirmative obligation to the lien holder). If there is a lien, the case is negotiated to resolution.

Medicare Conditional Payment FAQ

How much can the Medicare Advantage Plan Recover?

The MA Plan may recover the total amount of conditional payments made for injuries related to a Liability, Workers Compensation, and/or No Fault claim up until the date of settlement. Under current law the Medicare Advantage Plan  has the statutory right to request full reimbursement up to the full amount of the settlement if the total amount of related charges is equal to or greater than the settlement amount. If reimbursement is made as a result of a settlement, judgment or award, they should  reduce the lien amount based on a pro-rata share of the procurement costs (i.e. attorney’s fees and additional expenses).

What happens if I fail to repay my debt?

Failure to repay your debt within the specified time frame may result in additional recovery procedures. The Medicare Advantage Plan may also recoup this money from anyone else that has been given money from the settlement, including the beneficiary’s attorney.  Additionally, the Medicare Advantage Plan can double their recovery amount if they are not repaid.

TESTIMONIALS

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

"Synergy has been a trusted part of our legal team for many years. They have helped our clients in many cases to understand the benefits of structured settlements. Synergy has protected our clients and us by securing the best annuities on the market with the safest companies available. Our Synergy consultant is a great communicator in explaining the details and benefits of structured settlements to our clients. He has also mentored myself and the other lawyers in our firm in the benefit of Attorney Fee Annuities. Their work with our firm has secured our clients and our financial security and we expect to continue working with him for many years to come."

Brett Panter
Panter, Panter & Sampedro

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