Potential Waiver Indicators

50.17 – Potential Waiver Indicators (Rev. 10629; Issued: 03-23-21; Effective: 04-19-21; Implementation: 04-19-21) Waiver decisions are rarely, if ever, straightforward and uncomplicated. However, there are a few indicators to consider. The following are just examples and are in no way conclusive determinations of whether waiver should or should not be granted. Every waiver decision must be made on the merits of the facts in the case in question. Indicators that support granting full or partial waiver include: a) Medicare’s recovery exceeds settlement amount (this is often true with small settlements); b) Beneficiary sustained the type of permanent injuries, or has documented lost wages, or became unemployed; c) There are non-covered out-of-pocket accident related expenses; and d) Beneficiary’s living expenses are equal to or higher than income. Indicators that support denying waiver (where financial hardship is alleged) include: a) Medicare asserted its right to recover before the settlement proceeds were disbursed (and there is correspondence in the case file which provides documentation of Medicare’s timely assertion); b) Beneficiary receives a large settlement; c) Beneficiary’s income exceeds ordinary living expenses; d) After repaying Medicare and allowing for out-of-pocket medical costs (if such allowances are necessary), the beneficiary will be left with a substantial amount of the settlement proceeds; and e) Beneficiary has substantial assets.