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
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.
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.