If Medicare paid for treatment related to an injury claim, it may seek repayment when the case settles. Once you agree to your settlement, you think you will receive that money in your pocket, but if Medicare paid for any of your injuries, you may have to give some of that back.
This is where many older people become confused. If Medicare made related payments, it’s possible the recovery amount should be checked before settlement funds are distributed. An early estimate can change.
The 2026 Medicare Trustees Report estimates that 62.2 million people aged 65 or older were enrolled in Medicare during 2025. For seniors pursuing an injury claim, Medicare’s repayment rules may affect the final payout. These are the people who will need to be aware of this if they are seeking compensation for an injury.
Here’s what this guide covers:
- What is a Medicare Lien?
- You Will Not Receive Your Full Settlement Amount
- Medicare Lien Review and Payment
- Can You Lower the Amount Medicare Wants Back?
- Things to Keep in Mind With Injury Claims
- Make Sure to Protect Your Settlement
What is a Medicare Lien?
As stated above, a lien is a term used when discussing your settlement. Medicare refers to it as a recovery amount.
When someone is waiting for an insurance company to respond to their claim, Medicare may pay for some of those services. Medicare may make conditional payments for injury-related services that another insurer is ultimately responsible for.
Once that person receives a settlement, judgment or any form of compensation, Medicare can seek repayment for what they paid.
Say you are an elderly person who got in a car accident. Medicare could pay for your hospital bill while the at-fault party’s insurance is looking into your accident. Once your accident settles, you would need to look at those Medicare payments.
Medicare does not seek repayment for every visit in a person’s medical history. Its recovery claim concerns relevant payments tied to the injury or condition involved in the settlement.
You Will Not Receive Your Full Settlement Amount
Settlement amounts will vary for every individual. Just because your settlement amount is $80,000 does not mean you will walk away with $80,000. Medicare, your attorney, medical bills, etc all play a factor in how much you receive from your settlement.
Use that example of $80,000. Your Medicare payment information shows that Medicare paid $12,000 for services that may have to do with your accident. This does not mean that you will receive $68,000 in your settlement. There may be other services that need to be checked and your attorney fees, expenses, etc. will have to be taken out as well.
If you are living in the Dallas area and dealing with an injury, the attorneys at Freese & Goss can help you with your personal injury claim. No matter who you hire, make sure they know how much Medicare could want back from your settlement.
You want to know this information because you may not receive close to your settlement amount once all liens and expenses are deducted.
Medicare Lien Review and Payment
By knowing how Medicare collects money from settlements, you can avoid receiving money too soon or getting a bill in the mail at a later time.
Notify Medicare about your claim
Whether it is you, your attorney, or your representative, you should let the Benefits Coordination & Recovery Center (BCRC) know that you are involved in a claim that may involve liability, no-fault, or workers’ compensation insurance.
They will use this information to look at your file and see what payments Medicare made for your accident. If you have someone representing you, they can also access the Medicare Secondary Payer Recovery Portal to see your case information. The BCRC will need documentation that someone is representing you before they release that information.
Review your payment information
Medicare will send you a list of payments that they feel may relate to your case. This is only a preliminary amount; they can send you a bill for more after this review is completed.
Look at the information on your list of payments. The dates, what kind of treatment, and why that person went to that appointment are all important things to look at. Maybe that person went to their doctor for something unrelated to their accident; don’t assume that all of those payments were because of your accident.
You can dispute payments that were not related to your accident. You may need medical information and an explanation to back this up.
Report your settlement information
After your case has settled, you will want to report that to Medicare along with the amount you received and any attorney fees/expenses. Medicare may identify more related payments and issue a demand for the amount it says must be repaid.
You may also be able to do a Final Conditional Payment process before your case settles if you meet the requirements. You will need to be timely with this process, so don’t wait until the last minute.
Pay your bill or dispute
Once Medicare sends you a demand, you will want to know your options to either pay or dispute that amount. Make sure you don’t miss the due date on that demand; they may start charging you interest if you don’t pay your bill within that time frame, even if you are disputing it.
You should withhold some of your settlement money until Medicare has resolved their lien against you.
Can You Lower the Amount Medicare Wants Back?
Yes, but it is not as easy as you may think. Just because you are older and retired, or received less money from your settlement, Medicare is not going to lower their bill for you automatically.
You need to ask yourself two questions.
Did Medicare only bill you for payments that are related to your accident? You should review their claim to make sure that all the payments are related to your accident. If not, you may be able to dispute those payments.
Were your attorney fees and expenses factored into the demand? Medicare considers qualifying attorney fees and other costs paid by the beneficiary when calculating the amount it seeks to recover, using specific deduction rules. They follow certain guidelines when calculating this; it’s not something you and your lawyer can decide on.
You can always dispute your demand if you believe that Medicare billed you incorrectly. You can also request a waiver if you meet certain criteria, but Medicare cannot process a waiver until they have sent you a demand.
Just remember, the BCRC handles Medicare Part A and B claims. The BCRC process covers Original Medicare Parts A and B. Medicare Advantage and Part D plans are responsible for recovering any payments they are entitled to seek separately.
Things to Keep in Mind With Injury Claims
Some of the biggest settlement issues come from people thinking that someone else will handle their Medicare bill.
Don’t fall into these mistakes:
- Taking your settlement too soon – You could receive more Medicare claims after you receive your first payment information.
- Ignoring Medicare payments that aren’t related to your accident – Always review your list of payments and make sure they have to do with your accident.
- Spending your settlement right away – You may need that money to pay Medicare if they send you a legitimate bill.
- Other health coverage and Medicare plans – Check whether a Medicare Advantage plan, Part D plan, Medicaid, or another insurer may have a separate repayment claim. Make sure those are looked into as well.
You also want to keep in mind future medical bills. Medicare may bill you for past services, but you will also need to think about what medical bills you may have in the future. Workers’ compensation settlements have specific Medicare set-aside guidance for future care. Ordinary liability settlements do not use that same CMS review process, but future medical expenses still deserve attention.
Make Sure to Protect Your Settlement
When you receive a settlement, you want to use that money to better your life from what your injury took from you. If you are older, make sure you do your due diligence to protect your money.
Get your Medicare payment information updated, dispute any payments that aren’t related to your injury, review the likely repayment amount before settling, and resolve the final Medicare demand when it arrives. If you do receive a demand, make sure to get that resolved by the deadline.