On November 18, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the 2026 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Settlements, Judgments, Awards, or Other Payments. To download CMS’ Recovery Threshold Alert, click here.
As required by section 1862(b) of the Social Security Act, CMS is required to review the costs related to collecting Medicare’s conditional payments and compare these to recovery amounts. Until further notice, the threshold for physical trauma-based liability insurance settlements will remain at $750. Until further notice, CMS will also maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals.
This means that entities are not required to report, and CMS will not seek recovery on settlements, as outlined above. Please note that the liability insurance (including self-insurance) threshold does not apply to settlements for alleged ingestion, implantation, or exposure claims.
For Additional Information
Medivest will continue to monitor news and updates from CMS and will keep its readers up-to-date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us directly at 877.725.2467.
