MEDICARE LOW SETTLEMENT THRESHOLD REMAINS AT $750.00 for 2026
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CMS Announces 2026 Low Dollar Threshold for Liability Recoveries
Each November, the Centers for Medicare and Medicaid Services (CMS) releases updated thresholds that guide the reporting and recovery obligations tied to personal injury settlements. These thresholds play a crucial role in determining when a claim must be reported and whether Medicare will pursue reimbursement.
For 2026, CMS has confirmed that the liability recovery threshold will remain at $750.00, consistent with the amount set for 2025.
What This Means for Plaintiff Attorneys
When a liability settlement, judgment, award, or other payment totals seven hundred fifty dollars or less, there are two primary implications:
- No Reporting Required
- You are not required to report these settlements to CMS under the Medicare Secondary Payer rules.
- No Medicare Recovery Pursuit
- CMS will not assert recovery rights for any settlement that falls at or below this threshold.
Important Exceptions
As with most Medicare rules, there are critical exceptions that must be noted:
- Ingestion, Implantation, or Exposure Claims. Any settlement involving allegations of ingestion (e.g., toxic substances), implantation (e.g., medical devices), or exposure (e.g., asbestos or radiation) is excluded from the low dollar threshold protection. These cases must still be reported, regardless of the settlement amount, and are subject to full recovery efforts by CMS.
- No-Fault or Workers’ Compensation Claims with Ongoing Medicals. If the carrier has an ongoing responsibility for medicals (referred to as "ORM"), the claim remains reportable and Medicare’s recovery rights still apply. ORM creates a separate set of obligations unrelated to the size of the settlement.
A Strategic Takeaway
Although this update may seem minor, it is a valuable reference point for closing out low-value cases cleanly. This $750.00 threshold has remained unchanged since January 2017. Before that, the threshold was $1,000.00, but there has been no upward trend since the reduction.
Keep this figure in mind when managing smaller claims, especially those with potential Medicare implications. It is a useful tool when resolving matters that fall under the limit and do not meet either exception.
To stay current with evolving Medicare rules, explore our Medicare Module Series on the Lien Project Network.
Explore More Resources with Lien Project Network
For a deeper dive into lien resolution strategies, settlement planning, and reimbursement challenges, explore our educational modules. Lien Project Network serves as a trusted resource for plaintiff attorneys, providing insights on financial planning, public benefits, and structured settlements in the context of lien management.
Need Assistance? Work With The Lien Project, PC
If you need expert legal assistance in navigating lien resolution, reimbursement claims, or settlement planning, our team at The Lien Project, PC is ready to help. As an LPN member, you earn credits that can be applied toward lien reduction and resolution services provided by The Lien Project, PC, allowing you to offset up to $900 per year. Your investment in continuing education through Lien Project Network not only enhances your lien resolution skills but also reduces the cost of engaging legal experts when needed.
Schedule a Consult today to see how we can help maximize your client’s recovery.