Do Medicare and Medicaid Affect Your Texas Personal Injury Claim?

Do Medicare and Medicaid Affect Your Texas Personal Injury Claim?

The federal health insurance program known as Medicare covers individuals aged 65 or older and certain youngsters with disabilities. If a Medicare recipient gets in an accident, Medicare covers the medical care cost that the recipient had to bear recovering from the injury just like a Texas personal injury claim.

However, there is a condition tied to it. You cannot receive any settlement cost that you receive in a personal injury claim. If you do, the amount you received from Medicare would need to be returned. So, you either take the settlement from Medicare or a personal injury claim.

Is Medicaid Different from Medicare?

Medicaid and Medicare are both government-funded programs providing medical care benefits to qualified individuals. The difference between Medicare and Medicaid is that the former is a Federal program while the latter is a state-run program.

They make a legal lien for benefits paid for any past clinical costs that emerged because of a physical injury of an individual.

However, Medicare is not quite the same as Medicaid in that case. Federal government laws additionally demand Medicare set-aside amount that will be used to deal with any expense of future medical care.

Besides this, Medicare has a programmed lien on any payment you get from your Texas personal injury claim to ensure its lawful right to reimbursement. If you fail to timely report the result of any personal injury claim amount you received, it can cost you substantial fines that can be as high as $1,000.00 per day.

The lien provides Medicare with a claim to the settlement or judgment funds. And, by law, Medicare lien has superiority over any other entity or person, including you as the insured party.

One drawback of Medicare is that it doesn’t allow any negotiation in the lien amount. Whether it be more or less, you will have to accept it as they offer almost no flexibility.

What Is a Medicare Set-Aside?

Not only does Medicare reimburse past medical benefits, but it also demands both worker’s compensation and personal injury claimants to set some funds aside to pay for any future clinical costs that will be expected for Medicare to pay under particular conditions.

The regulations of this policy are poorly formulated and are inconsistent. Nonetheless, right now, the government obligates you to make a Medicare Set-Aside if you are either of the following:

  • A current Medicare beneficiary settling for more than $25,000 personal injury claim
  • Not a current Medicare beneficiary but would rather settle for more than $250,000 and can be expected to get Medicare within 30 months of settlement.

Medicare and Medicaid Reimbursement Rates:

Medicare and Medicaid are extraordinarily good at negotiating with medical professionals because of their experience in dealing with a large number of similar cases. They know exactly what to say and do to get the best possible deals on medical care for their patients.

Thus, while other patients may get charged $10,000 for the recovery of a specific injury, a Medicare, as well as a Medicaid client, might be paying $500 for a similar procedure which equals almost nothing considering the real cost. The rest of the amount i.e. $9,500 gets discounted.

This is significant on the grounds that under Texas law, you are not allowed to claim recovery for the part that was discounted, and neither will the jury be informed about the real cost of the injury cost that was paid at a discounted price.

The amount of hospital expenses is the source for the jury to determine and grant for pain and suffering compensation. So when a jury of your Texas personal injury claim hears that a patient just got $500 in medical bills, they are significantly more liable to award commensurate with $500 than they actually are in $10,000 in damage.

In this case, it is wise to think if you want to get the Texas personal injury claim or not as only bringing it to trial may cost you easily around $5,000.

Get in Touch With a Personal Injury Attorney Today!

Getting Medicare or Medicaid can be a risky deal. The reason is that anytime you get a personal injury because of the negligence of another individual and Medicare or Medicaid pay for your medical bills, it is always going to negatively affect your personal injury case.

So, if you wish to file a Texas personal injury claim to get well-deserved compensation for your injury, contacting an expert personal injury attorney from Brent Coon & Associates can be your best option. Contact us today to get a free case review or get in touch with us online!


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