May 2011

Duty to Protect Medicare's Interests

In a recent Town Hall teleconference with the Centers for Medicare and Medicaid Services (CMS), one caller pressed CMS to cite the statute or regulation that specifically requires insurers to "protect Medicare's interests." CMS responded by simply referring the caller to the full MSP statute, at 42 U.S.C. § 1395y(b) generally, and to Sections 5.4 and 19 of the Section 111 NGHP User Guide. CMS's response to the caller's questioning for a citation to the words "duty to protect" was that the obligation to pay on a primary basis is an obligation to protect Medicare's interests. Please call or contact us for more information about your particular situation. We would be pleased to help you with this confusing and frustrating section of the MSP statute.

Understanding Your Medicare Benefits & Medicare Set Asides

Each year the Department of Health and Human Services (HHS) publishes their updated Official U.S. Government Medicare handbook with important information to know. Thus when Medicare Set Asides are completed on insurance claims a Beneficiary must preserve his/her Medicare Benefits by setting aside a portion of the settlement money in a segregated interest baring account to pay for future Medicare covered benefits. Once the set-aside account is exhausted, with the understanding that the Beneficiary has complied with all requirements under the law, then full Medicare coverage is provided for any Medicare covered healthcare. To check out (HHS) actual Medicare Handbook that is published yearly, please see the below link.

Click here for more information.

Did You Know That CMS Actually Has Criteria for Determining Whether a Lump Sum or Structured Settlement Sufficiently Takes Into Account Medicare's Interests?

The Centers for Medicare and Medicaid Services (CMS) considers whether the amount allocated for future medical expenses is reasonable. In addition, the repayment of conditional payments made by Medicare should be taken into account.