What is Medicare Set Aside?

What Is Medicare Set Aside?

When a worker’s compensation case settles, Medicare wants to make sure that it will not have to pay for medical treatment that would have been covered by the WC carrier. Consequently, vendors are hired to predict and estimate your annual medical care costs for your work injuries during the remainder of your lifetime. This is commonly referred to as a MSA. Once the assessment is completed by a vendor, it is submitted to the Centers for Medicare Services (CMS) to approve the MSA. If CMS approves the MSA, then part of your settlement money will be put into an MSA account, which you will manage; or an annuity will be created that pays you once per year the estimated future medical care expenses. During the year, you will withdraw money from your MSA account to pay for your work related injuries. Once you have spent the amount required each year by the MSA, Medicare will then pay for any treatment you need for your work injuries for the rest of the year. You will be required to provide an itemization of your medical expenses to Medicare each year.      

Medicare will always pay for non-work related conditions. The MSA is your money and you may transfer it to your heirs upon your death unless you have an annuity. The annuity would stop upon your death. The main advantage of an annuity is that it provides more money in your pocket up front.  If you want, we can discuss this option in greater detail. You may spend the MSA money on other things besides your work related injuries.  However, if you do so, Medicare will not pay for any work related treatment until you spend the amount you were required to do so by the MSA. You will not go to jail or be sued if you spend your MSA money on non-work injury items, but you will lose your ability to access medical care for your work injuries from Medicare if you do so.