Once an injured individual settles their case, resources that were once available pre-settlement to help make decisions around their care, such as their adjuster or nurse case manager, are no longer available. It can be daunting for them to determine what is and is not Medicare-covered when making healthcare decisions that can ultimately impact their out-of-pocket costs.
A good professional administrator works in the best interest of the injured individual and can help guide some of these medical decisions to help the individual avoid having to pay out-of-pocket costs. The administrator can provide helpful resources and education on Medicare guidelines and requirements for MSA recipients and offer helpful alternative solutions for Non-Medicare covered items, helping to extend the life of the MSA account funds.
If an injured individual settles with a Medicare Set Aside (MSA), their treatment and medications expensed with those funds must be Medicare-covered and related to their injury. Some of the major benefits of an injured individual settling their workers’ compensation or liability case are having freedom to treat where they would like and freedom from utilization review. However, at Ametros we often find that injured individuals may still have certain desired treatments and medical expenses that are not covered by Medicare, now that they are able to have more control over their treatment plan after settlement.
We’ve compiled a list of our most frequently requested items and services that are not covered by Medicare and alternate options that can help satisfy care needs and save money on out-of-pocket costs.
- Massage - Massages are covered by Medicare when it is performed by a licensed physical therapist as part of an injured individual’s treatment plan.
- Personal Care Attendants - Intermittent skilled nursing care or other skilled services such as in-home physical therapy are all covered services.
- Dental - Dental service providers may work with injured individuals on monthly payment arrangements to make the cost of non-covered services more manageable.
- Out of Country - Medicare does not cover services outside of the United States. A professional administrator can work with injured individuals to assist in obtaining cost effective, in network services.
- Botox Injections - Medicare does not cover Botox for cosmetic purposes, however it may be covered to manage migraine pain.
- Lift Chairs - Medicare does not cover furniture, but covers the seat lift mechanism. If a temporary solution is needed, injured individuals may be able to rent from a local DME supplier.
- Unclassified - Biofreeze, gloves, hot & cold packs, and shower chairs, are not covered. Injured individuals can often find coupons available for these items to reduce out-of-pocket costs.
Injured Individuals Can Save on Non-Medicare Covered Items with Amethyst
If an injured individual has an MSA, in order to comply with Medicare’s requirements, their MSA account funds cannot pay for expenses that are not covered by Medicare. Our Amethyst service can provide them with discounts on these non-Medicare covered items. Amethyst connects to their debit card, and they receive an Amethyst card, similar to an insurance card, to show at the pharmacy or doctor’s office to use on these non-Medicare expenses. Amethyst applies charges to their debit card on file, facilitating payments on their behalf and applying discounts.