What's covered by a Medicare Part C Plan?

Question: I am handling a lawsuit on behalf of a claimant against a self-insured entity. The claimant is enrolled in a Part C plan. The defendant is insisting as a part of settlement (at the last minute) that claimant provide proof that "Medicare has no lien." My understanding is that Medicare would not have a lien because in this circumstance, the secretary pays a premium to the private health insurance company to provide benefits similar to Medicare benefits. If a Medicare HMO, such as private health insurance company, provides benefits, the secretary of the Department of Health and Human Services does not make conditional payments, so the secretary's reimbursement rights under the Medicare Secondary Payer statute would not be applicable. I have, by the way, settled with Humana as to the monies owed to it.

Florida Attorney

Answer: Thank you for the question. Your understanding is correct so long as the entire time in which your client was receiving injury related care they were covered by the Part C plan. The Part C program allows eligible individuals to elect to receive Medicare benefits through enrollment in private insurance plans. Part C enrollment happens on an annual basis and if your client received benefits under the Part C plan only, Medicare (part A & B) would not have made payment. The only exceptions are cases were the beneficiary was treated at a teaching hospital or received hospice. In these two scenarios traditional Medicare makes payment even though the beneficiary is covered under a Part C plan. Thus under the situation described below it is very possible that no conditional payments were made by Medicare.

I hope you found this helpful and please let me know should you have any additional questions.