US · guidance
CMS Pub. 100-05, ch. 2, § 60.1
Medicare’s Recovery Rights
Medicare has a statutory direct right of recovery from the no-fault insurance as well as any
entity that has received payment directly or indirectly from the proceeds of a no-fault
insurance payment. Medicare's recovery rights take precedence over the claims of any
other party, including Medicaid. Medicare's recovery right is superior to other entities
including Medicaid because Medicare’s direct right of recovery is explicitly prescribed in
Federal law and other entities’ recovery rights are based on either State law or subrogation
rights.
In addition to its direct rights of recovery, Medicare also has subrogation rights.
"Subrogation" literally means the substitution of one person or entity for another. If
Medicare exercises its subrogation rights, Medicare is a claimant against the no-fault insurer to the
extent that Medicare has made payments to or on behalf of the beneficiary for services related to
claims against the no-fault insurer. Medicare can be a party to any claim by a beneficiary or other
entity against no-fault insurance and can participate in negotiations concerning the total no-fault
insurance payment and the amount to be repaid to Medicare.
History
(Rev. 11755, Issued:12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
15a72f4ac430cca255b8b0ce67e52ef8ed436834ea82d26a4ba8c06462d93667
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