When to Consider Medicares Interests by Numibx


									                            WHEN TO CONSIDER MEDICARE’S INTERESTS

                                                          SCENARIO I
                                           Is the claimant a Medicare beneficiary?

                                  YES                                                           NO

If the total settlement amount          If the total settlement amount is                             Look to see if the claimant falls
is greater than $25,000,                $25,000 or less, a pre-approved                               under SCENARIO II below
CMS must pre-approve an                 MSA proposal is not necessary;
MSA proposal                            however, Medicare’s interests
                                        still must be considered

                                                                                                                  You must secure a
                                                                                                                  final demand letter
  You must secure a conditional payment lien letter from the MSPRC                    AFTER                       from the MSPRC

                                                           SCENARIO II
                If the total settlement amount is greater than $250,000 AND there is a reasonable
                expectation of the claimant becoming a Medicare beneficiary within 30 months from the date
                of the settlement, CMS must pre-approve an MSA proposal.

                                                                                      If the claimant meets one or more of these
      1.   Currently receiving SSD benefits                                           criteria and the total settlement amount is
      2.   Has applied for SSD benefits                                               $250,000 or less, a pre-approved MSA
      3.   Previously received SSD benefits and remains                               proposal is not necessary; however,
           eligible                                                                   Medicare’s interests still should be considered
      4.   Denied SSD benefits, but is appealing denial
      5.   62.5 years old or older
      6.   End Stage Renal disease

                         Include the following in calculating the TOTAL SETTLEMENT AMOUNT:

                             1.    Money paid at time of settlement for future medical expenses, including
                                   prescription medications (MSA allocation)
                             2.    Money paid at time of settlement for indemnity/vocational benefits
                             3.    Advances paid as part of settlement
                             4.    Attorney fees and costs paid in settlement
                             5.    Medicare conditional payment claims, if any
                             6.    Money paid in prior settlement or award
                             7.    Third-party settlement amount including value of liens waived

           If questions regarding the information arise or you are uncertain whether an MSA is needed, please contact us:
                                        BLEAKLEY, CYPHER, PARENT, WARREN & QUINN, P.C.
                                                      Toll-Free: (866) 677-9243
                                                     Website: www.bcpwq.com

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