In simple terms, a Medicare Set-Aside (MSA) is an allocation of funds from a workers' compensation settlement that is set aside to cover the cost of future medical expenses related to the injury that led to the settlement. The purpose of an MSA is to protect Medicare's interests and ensure that Medicare is not responsible for paying for medical expenses that should be covered by the workers' compensation settlement.
When an individual is injured on the job and receives workers' compensation benefits, Medicare may also be responsible for covering the cost of medical treatment related to that injury. However, if the individual later receives a settlement or award for the injury, Medicare may seek reimbursement for any medical expenses related to the injury that it has already paid.
To avoid this situation, the Centers for Medicare and Medicaid Services (CMS) created the MSA program. The program allows for the allocation of funds from a workers' compensation settlement to cover the cost of future medical expenses related to the injury. By doing so, Medicare's interests are protected, and the individual can receive the full benefit of their workers' compensation settlement without fear of a Medicare lien.
MSAs are generally required in workers' compensation cases when the settlement amount exceeds a certain threshold and the injured party is currently or expected to become a Medicare beneficiary within a certain timeframe. The threshold amount varies from state to state, but it is typically around $25,000.
In order to determine the appropriate amount to allocate to an MSA, a qualified individual must first evaluate the injured party's medical records and treatment history. This individual will then consider the cost of future medical treatment, including doctor's visits, medications, physical therapy, and any other necessary medical care related to the injury.
Once the appropriate amount has been determined, the funds allocated to the MSA must be deposited into a separate account and used exclusively for the payment of future medical expenses related to the injury. The injured party must keep track of all medical expenses paid from the MSA and report them to CMS on an annual basis.
If the MSA funds are depleted and the injured party requires additional medical treatment related to the injury, Medicare will begin paying for the treatment. However, if the MSA funds are not depleted and the injured party receives additional medical treatment related to the injury, the funds remaining in the MSA may be returned to the injured party.
In conclusion, Medicare Set-Asides are a necessary component of many workers' compensation settlements. They are designed to protect Medicare's interests and ensure that the injured party receives the full benefit of their settlement without fear of a Medicare lien. If you are involved in a workers' compensation case, it is important to consult with an experienced attorney to determine whether an MSA is necessary and, if so, how much should be allocated to it.