According to the Medicare Secondary Payer (MSP) statute, parties to an insurance settlement involving Medicare beneficiaries are responsible for protecting Medicare’s financial interests. This is done through a Medicare Set Aside (MSA), which is a tool used in settlements to determine what amount is appropriate to “set aside” for future Medicare-covered medical expenses related to an injury. The statute applies to workers’ compensation, no-fault, and liability claims.
What is a Medicare Set Aside Allocation?
An allocation is the process of determining how much money must be placed in an MSA. An allocation expert will do an in-depth evaluation of the injured party’s medical record to determine what future treatment may be necessary. Next, Medicare regulations are reviewed to determine what portion of the medical services would normally be covered by Medicare. A final projection is made of the likely expenses for the covered treatment based upon the applicable medical reimbursement fee schedule. This is the amount that should be placed in the MSA. Different cases such as workers compensation and liability will have a different set of guidelines for medicare set aside allocation.
MSA Funding Options
The Centers for Medicare and Medicaid Services (CMS) requires that an MSA allocation be funded in one of two ways:
- A lump sum settlement which includes a full and final resolution of the carrier’s liability for indemnity and for all future medical benefits.
- A structured settlement which is tax-free and operates like a deductible. It typically reduces the amount that has to be set aside substantially.
An MSA can be self-administered by a competent client or professionally administered, and must be put into an interest-bearing account and account for terms of expenditures. With self-administration, the client must submit an annual self-attestation form when monies have been exhausted. With professional administration, the administrator must forward annual accounting summaries concerning the expenditures to the CMS Medicare contractor responsible for monitoring the individual’s case.
Professional Medicare Set Aside Services
If your client is a Medicare beneficiary with a settlement exceeding $25,000 or has a reasonable expectation of becoming a Medicare beneficiary within 30 months with a settlement that exceeds $250,000, Medicare’s interests simply cannot be ignored by an attorney or client.
Let our experts assist you with all of your client medical set aside needs. We will provide CMS with all of the relevant facts concerning your client’s injury and medical treatment. Getting CMS approval of your client’s allocation is critical to ensure that primary payer compliance is met and future Medicare eligibility is secured.
For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.
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.