On November 12, 2026, the Centers for Medicare & Medicaid Services (CMS) issued its annual alert on the low-dollar recovery threshold for Non-Group Health Plan (NGHP) claims. The short version: nothing changes. The threshold stays at $750.
What The Alert Says
Section 1862(b) of the Social Security Act requires CMS to weigh what it costs to collect Medicare's conditional payments against what it actually recovers. Having completed that review, CMS announced that the $750 threshold will continue to apply to:
Liability insurance (including self-insurance) settlements based on physical trauma
No-fault insurance settlements, where the insurer does not otherwise have ongoing responsibility for medicals (ORM)
Workers' compensation settlements, where the workers' compensation entity does not otherwise have ORM
For settlements that fall within the threshold, primary payers are not required to report, and CMS will not seek recovery. Note that the liability threshold does not apply to settlements for alleged ingestion, implantation, or exposure claims, which remain reportable regardless of amount.
The Bottom Line
For primary payers and settling parties, the alert means continuity. With the threshold unchanged, no adjustments to existing processes are required. Still, the annual alert is a good prompt to confirm that reporting workflows and settlement protocols are current, accurate, and applied consistently across claims.
If you have questions about how the threshold applies to a particular claim or settlement, please contact us.