What is Considered a Class I and Class II Beneficiary for a Medicare Set Aside?

There are many reasons why personal injury law firms outsource Medicare Set Aside services (MSA) to a professional that specializes in this specific area of settlements. The main reason trial attorneys seek assistance with MSAs is that the rules are extremely complicated. At Synergy Settlement Services, our team of experienced consultants can focus on the future medical cost projections of the settlement and ensure you are in compliance with all rules and regulations related to MSAs. This way you can remain focused on the important legal aspects of your case.

In this brief article, a settlement professional will discuss the qualifications for Class I beneficiaries and Class II beneficiaries for MSAs. Remember, for any of your law firm’s settlement needs, an experienced consultant is here to assist you.

What is Considered a Class I Beneficiary?  

When the future medical expenses are going to be secured through an MSA, the claimant must meet one of the following requirements to be considered a Class I beneficiary:

  • The claimant is 65 years of age or older
  • For at least two years (24 months) or longer, the claimant has been utilizing Social Security Disability (SSDI)
  • The claimant suffers from End Stage Renal Disease (ESRD)

If the settlement is valued at a total of $25,000 or greater, the MSA amount should be submitted to Medicare for their review and approval. This process ensures that Medicare’s interests are protected.

What is Considered a Class II Beneficiary?   

In order to be considered a Class II beneficiary, the claimant’s settlement total must be greater than $250,000 with a “reasonable expectation” of Medicare enrollment within a period of 30 months. In order to qualify as a Class II beneficiary, the claimant must meet one of the following requirements:

  • The claimant is 62 years and 6 months of age and will be eligible for Medicare within the next 30 months
  • Although the claimant is not eligible for Medicare, they are on SSDI  
  • The claimant has applied for SSDI or is appealing a denied SSDI ruling
  • The claimant suffers from ESRD, but does not qualify for Medicare yet

From structured settlements to special needs trusts to ensuring that settlement funds are appropriately managed and in compliance with the law, the settlement professionals at Synergy Settlement Services assist attorneys every step of the way with their settlement needs.

For more information about identifying a medicare set aside for personal injury cases 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.

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“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.

Understanding Structured Settlements and Medicare Set-AsidesThird Thursday Webinar Series

The parties agree that a Medicare Set-Aside is needed, now what? In this month's webinar, presented by Synergy CEO, Jason D. Lazarus, you will learn about the process basics for setting up a set aside including MSA allocations, funding mechanisms for set-asides, post-settlement administration as well as an overview of the process to make sure you close the case compliantly.

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