Medicare Set Aside
Medicare Set Aside (MSA) agreements are becoming an increasingly daunting consideration for claims adjusters. To avoid fines and penalties, cost projections must be as accurate as possible, but this procedure can be confusing.
An MSA can complicate a claim settlement—but it doesn’t have to.
Medicare Set Aside for Workers’ Compensation & Personal Liability Claims
After an injury or illness, medical expenses can accumulate quickly, and in many cases, the injured party will be faced with ongoing medical costs for the future as well. If a workers’ compensation or personal liability settlement is received, part of the funds must be “set aside” to cover future injury-related expenses. This is done with a Medicare Set Aside account.
An MSA in workers compensation or personal liability cases protects the injured party’s future Medicare eligibility, and it also protects the interests of Medicare in situations. The primary payer—the workers’ compensation or personal liability insurance settlement—is responsible for all ongoing treatment related to the injury, while Medicare is considered a secondary payer. Only after the allocated funds have been depleted can the related medical costs be shifted to Medicare.
An MSA can be set up regardless of the settlement amount, but it must be reviewed and approved by the Centers for Medicare & Medicaid Services (CMS) if the claimant falls into one of the following categories:
The claimant already receives Medicare AND is receiving a settlement of more than $25,000.
The claimant does not yet receive Medicare but has a “reasonable expectation” of enrollment within 30 months (e.g., they are age 62.5 or older, or have applied for Security Disability Insurance) AND is receiving a settlement of more than $250,000.
Getting to know the Medicare Set Aside basics can help you recognize when an agreement is required, but determining the appropriate amount to allocate to the MSA is less clear-cut. Extensive medical cost projections will be needed to ensure the account is not over-funded or under-funded.
How Palmetto’s Medicare Set Aside Experts Can Help
Our Medicare-certified consultants and certified life care planners can determine the appropriate amount of money that should be allocated to pay for the claimant’s future medical needs. We will develop an arrangement between settling parties of a claim that helps protect Medicare’s interests and those of the injured client.
We Assist Carriers in Meeting Regulations By:
- Thoroughly researching and analyzing each case
- Assuring accurate and timely report and registration implementation
- Completing accurate and rapid MSA cost projections