Medicare Part C

Posted by Matthew Garretson

Question:
Currently, I represent a lady covered under Wellcare PFFS which is self-described as a Medicare advantage private fee-for-service plan. Under these circumstances and assuming there is no inpatient hospitalizations, who has a right of subrogation/recovery? Does Medicare, Wellcare or both have any right of recoupment? I already plan to submit a SSA-3288 request for information from the social security administration but wanted to run this by you as well. Also, are there any other special concerns I need to be aware of under these circumstances? Thanks in advance for all your assistance.

-Ohio Attorney

Answer:
Under these facts, the right of recovery would lie with Wellcare. As a general rule, you need to look at the plan language because these are programs that “may” assert a right of recovery (under the applicable statute), but they must have it in their plan language. Hope that helps…