Medicare Lien Formula Explained

Medicare is the Federal health benefit available to seniors and those determined to be disabled by Social Security Disability. Every pay check you get has taxes taken out to pay Medicare. If you have a personal injury case and receive a settlement, Medicare has a right to be paid back for any medical costs they have paid as a result of some third party’s negligence. Think of it as Medicare “loaning” you the money until you get your settlement.

Medicare Formula: They don’t get all the money

Medicare “allows” for attorney fees when they get their money back. Here is how that works:

HOW to Reduce Medicare’s Lien:

1.Total Amount of Liability Settlement:$________

Amount of Medical Pay Settlement: +$ _____

TOTAL Received(ITEM A)$________

2.Amount of Attorney’s fees$________

Other Procurement expenses/cost+$ _____

TOTAL Fees/Costs (ITEM B)$ ________

3. (ITEM B) $_________ ÷(ITEM A)$_______ = RATIO._____

4.LIEN x RATIO = $ ________Reduction Amount

5. LIEN – Reduction Amount = FINAL LIEN $__________

Here is an actual example of how the lien works out using a “real life” scenario:

EXAMPLE

Medicare Claims $40k

$100,000 Settlement

+$5,000 Med Pay

$105,000ITEM A

$33,333.33 Attorney Fees

+$ 5,642.00 Costs

$38,975.33ITEM B

Item B $38,975.33 ÷ Item A $105,000 = .3711

$40,000 (total lien claimed) x .3711= $14,844.00 Reduction Amount

$40,000 – $14,844 = $25,156 FINAL LIEN

Because Medicare is a Federal Program, this formula should hold true for any state in the nation. Of course, each area will have a different Medicare contact number.

Chris Nichols
www.NicholsTrialLaw.com