US · guidance
CMS Pub. 100-05, ch. 3, § 30.2.1.2
Liability Claim Also Involved
If the individual files a claim against a third party for injuries suffered in an accident, the
provider may bill Medicare conditionally for otherwise covered expenses to the extent that
payment has not been made, or cannot be made promptly by a no-fault insurer or liability
insurer. For example, a Medicare beneficiary incurs $20,000 in medical expenses due to an
automobile accident. The individual receives $5,000 in no-fault insurance benefits and also has a
liability claim pending against the driver of the other car. Medicare does not pay benefits for the
$5,000 in expenses paid for by the no-fault insurer but does pay benefits based on the additional
$15,000 in expenses. Medicare recovers from the liability insurer or the beneficiary when the
liability claim is settled.
History
(Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e1b684b975c676543099140d7d60b94639b83a12423a9190527e8461a42b3093
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