Does Your Client Require a Medicare Set-Aside Arrangement?

A Medicare set-aside arrangement is a fiscal agreement that assigns a portion of a plaintiff’s personal injury awarded settlement to fund their future medical needs (medical visits, surgeries, medications, etc.). These medical services must be directly related to the injury the plaintiff suffered in order to receive the settlement and the funds must strictly be spent to cover the costs of the services prior to Medicare covering any of these services. In other words, Medicare is the secondary payer after the set-aside arrangement funds have been exhausted.

Consult With Set-Aside Experts

When a plaintiff is awarded a settlement, understanding Medicare set-aside requirements and determining the amount of funding that should be allocated into this arrangement is best left to a Medicare set-aside services specialist. No two Medicare set-aside arrangements are exactly the same and each case needs to be evaluated on an individual basis. In this brief article, our settlement experts will discuss Medicare’s requirements for claimants to be considered for a workers’ compensation set-aside arrangement.

Medicare Set-Aside Requirements

When an awarded settlement exceeds $25,000, if the claimant is eligible for Medicare, they are required to create a set-aside account. However, if the claimant is not eligible for Medicare, they are only required to create a set-aside account if the settlement exceeds $250,000. Generally, claimants that are 65 years of age or older require a set-aside account; however, claimants can be qualified for Medicare before the age of 65 if they are disabled or have been paid Social Security disability income for at least two consecutive years.

Following Rules and Regulations

It’s important that claimants are aware that their future Medicare benefits can be compromised if they fail to comply with the strict regulations set forth by their Medicare set-aside arrangement. This includes the following rules:

  • Claimants can only spend their set-aside arrangement funds on medical expenses related to the injury they received the settlement money for.
  • All documents related to these medical expenses must be preserved.
  • Annually, these expenses need to be reported to Medicare.

With many complex regulations, it’s important to contact a settlement expert that specializes in Medicare set-aside services. Our experienced settlement professionals can focus on your client’s Medicare requirements and ensure that they are in compliance with the rules and regulations set forth by Medicare. If you need assistance developing and overseeing a Medicare set-aside arrangement, contact us today.

For more information or to schedule a consultation, please submit our contact request form.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

Ready to schedule a consultation?

The Synergy Settlements team will work diligently to ensure your case gets the attention it deserves. Contact one of our legal experts and get a professional review of your case today.

Request Consultation


“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

WordPress Image Lightbox