People who are 65 or older or receiving Social Security Disability benefits may be covered by Medicare.
However, if you have Medicare and got hurt in an accident caused by someone else, Medicare will have a lien against any settlement you receive if it pays for your medical care.
Because Medicare liens can get complicated, you need a personal injury lawyer in North Carolina to handle your case for you. At Kreger Brodish LLP, we are prepared to protect your rights and pursue the compensation you deserve.
Call us today for your free, no-obligation consultation.
What Is a Medicare Lien?
A Medicare lien is a legal claim Medicare has against a settlement or judgment an injured person receives.
The lien covers medical expenses Medicare paid for that are the responsibility of the at-fault party. Personal injury cases, such as auto accidents or motorcycle crashes, and workers’ compensation claims often have Medicare liens.
When Medicare Liens Apply in North Carolina Injury Cases
Medicare’s right to impose such a lien is granted by law.
If Medicare covers you, you were injured, and Medicare paid for your treatment, a Medicare lien will attach as soon as Medicare pays. Because it’s a federally funded program, Medicare has a priority right of recovery.
That means their lien will be paid from your settlement or award before any other liens are paid.
Medicare liens attach as soon as the agency pays for your medical care. Because they automatically have a right to reimbursement, Medicare does not need to provide notice of the lien.
The Medicare Lien Process Step-by-Step
After you get hurt and realize that Medicare will be paying for your treatment, you must take the following steps:
- You or your lawyer must notify Medicare’s Benefits Coordination & Recovery Center (BCRC) of a claim against a third party. Your notification starts the recovery process and should be sent before any settlement is finalized.
- As your claim progresses, you may wonder how to get a “Conditional Payment Letter” (CPL) from Medicare. The answer is simple: you’ll need to request one from BCRC. A conditional payment is one that Medicare makes with the expectation that it will be reimbursed by the primary payor (the at-fault party or their insurer). The CPL provides an interim estimate of your total lien.
- Once your case is concluded, you must provide the BCRC with proof of your final settlement or award. The proof must include the date, total amount, and a breakdown of attorneys’ fees and costs. The BCRC will issue a Final Demand Letter within 30 days. This document provides the final lien amount.
- You or your attorney must pay Medicare the lien amount within 60 days of the date the letter was issued. Failure to pay may result in collection actions.
By following these steps, you can be sure that Medicare is properly reimbursed, which would prevent them from fining you or otherwise penalizing you for not reporting your claim.
Medicare Set-Asides vs. Medicare Liens: Clearing the Confusion
A Medicare set-aside arrangement (MSA) is a financial arrangement that sets aside a portion of a personal injury or workers’ compensation settlement to cover future injury-related medical expenses.
The MSA does two things.
First, it protects Medicare’s interests by making sure Medicare doesn’t pay for treatment covered by the settlement. Second, by setting aside funds for expenses Medicare would otherwise cover, an MSA allows an injured party to manage their own future healthcare expenses.
A Medicare lien, on the other hand, is a legal claim against a settlement or award. In a Medicare lien, the money goes to Medicare to reimburse it for payments it has already made on the injured party’s behalf. No money is set aside for future medical expenses.
How Medicare Liens Can Be Reduced or Resolved
Unlike liens made by other healthcare providers, Medicare liens are usually non-negotiable.
After you verify that the amounts listed in the final demand letter are accurate, you may still have options. You could reduce your lien amount under certain circumstances by doing the following:
- You could request a financial hardship waiver if you did not contribute to the injury.
- You can request a compromise after an offer has been made or a settlement has been finalized.
- If you receive a settlement of less than $5,000, you can request a fixed percentage settlement.
- You could request a self-calculated conditional payment amount if your settlement is $25,000 or less.
- You can request a $300 threshold on liability settlements if your settlement was $300 or less.
Common Mistakes That Cost Injured Claimants Money
You might take some actions that could harm your financial recovery. Keep the following elements in mind with regard to your Medicare lien:
- Don’t rely on CPL numbers as final figures.
- Identify potential Medicare liens right away.
- Don’t confuse the date of diagnosis with the date of injury.
- Use the correct methods to resolve conditional payments; go through Medicare.
Why Medicare Lien Compliance Is Critical in 2026
The Centers for Medicare and Medicaid Services (CMS) has new regulations that apply this year that could affect your lien.
Additionally, any changes to your current Medicare plan could affect your lien resolution. Additionally, if you have a Medicare Advantage plan, you must contact your plan to negotiate Medicare expenses because they have the same rights of recovery that Medicare has.
Talk to an experienced North Carolina personal injury lawyer about how any new changes in laws affecting Medicare and Medicare liens could affect your lien.
How a North Carolina Personal Injury Firm Helps Protect Your Settlement
After you’ve been hurt in an accident caused by someone else, you have enough to worry about with just healing your injuries. You shouldn’t also have to pursue the money you need. A North Carolina personal injury firm can help by doing the following:
- Investigating the accident
- Gathering evidence
- Identifying the responsible party
- Filing a claim with the at-fault party’s insurer
- Negotiating with the insurance company for a fair settlement
- Discovering any liens attached to your settlement
- Negotiating for reductions in those liens where possible
- Paying all lienholders
- Answering all your questions
Here’s what one of our former clients said about working with us:
“Great experience working with this law firm. The service I received exceeded my expectations.”
– Tyrelle B.
Contact Our Personal Injury Lawyers in North Carolina Today
Hurt in an accident that wasn’t your fault?
Call Kreger Brodish LLP today for a free, fully confidential consultation about how we can pursue the compensation you deserve.
