Medicare/Medicaid/Medi-Cal? What is the difference?
Medicare, created in 1965, ?is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicaid is the United States health program for certain people and families with low incomes and resources that is managed by the states. ?In California it is known as Medi-Cal ?and it is a means-tested program that is jointly funded by the state and federal governments ?A means test is a determination of whether an individual or family is eligible for help from the government, based upon whether the individual or family possesses the means to do without that help.
An easy way to distinguish between the two is to remember that MediCARE is CARE to the Elderly and Disabled and , MedicAID?is AID to the poor.
Under Federal law Medicare has a right to recover for medical bills they have paid. ?Similar to the Medi-Cal Lien Laws, Medicare liens can be placed on the personal injury case of a person whose treatment is paid by Medicare. ?Medicare?s agents have a right to recover funds which would not have been paid without the negligent act which harmed the plaintiff-beneficiary.
What obligations do parties have to report to Medicare in a liability settlement?
Your Personal Injury Attorney will report to the Coordination of Benefits Contractor (COBC) with information such as the Medicare number, injury, date of injury/loss, and other pertinent information. ?Later, they must submit consent forms and proof of representation to the Medicare Secondary Payer Recovery Contractor (MSPRC). ?Then you and your attorney can address any unrelated payments and dispute those payments. Finally, a settlement should be immediately reported to Medicare?s MSPRC.
You may be wondering: ???Why do I have to pay them anything out of my settlement??
Medicare is considered a secondary payer of benefits. The laws are made to protect Medicare from either unpaid medical bills or reimbursement for bills already paid. The legal concept is to prevent a double recovery for medical bills paid by others. The law takes the position that since Medicare paid your bills, any monies that you recover from the responsible party should be repaid to them first before you receive any balance.
The Medicare laws are ?becoming more complex all the time because Medicare?s funds are rapidly decreasing. Medicare lien reimbursement rules are currently in flux and new laws are designed to recover more of the money that Medicare pays out to beneficiaries that should be paid by another insurer or entity.
In order to adequately protect yourself, you will need a knowledgeable personal injury attorney to determine if you are being offered fair value for your claim. ?If you have been injured and you are a Medicare recipient, contact the Law Office of Peter S. Cameron at 877-603-8473, ?As an experienced San Diego Personal Injury Lawyer, Mr. Cameron can negotiate for the best settlement in your favor.
This article is for educational and marketing purposes only. ?It does not create an attorney-client relationship.
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