When your MSA funds are exhausted or depleted, CareGuard will notify both you and Medicare. If the appropriate attestation and supporting documentation are submitted demonstrating compliance with Medicare Set-Aside requirements, Medicare may step in as the primary payer for Medicare-covered, injury-related services during the period of exhaustion or depletion. It is important to continue having your healthcare providers bill CareGuard for your treatment during this time.
Billing After MSA Exhaustion
Even after your MSA funds run out, your providers should still send their bills to CareGuard. They will receive an Explanation of Review (EOR) showing a denial, which instructs them to bill your secondary insurance. Ensure your providers have your secondary insurance information to proceed with billing.
Role of Secondary Insurance
Your secondary insurance plays a crucial role once your MSA account is depleted. You must provide this information to your provider if it hasn’t already been done.
Annuity and Replenishment of Funds
If you have an annuity, MSA funds will be replenished periodically. Once replenished, your MSA account will resume covering expenses as the primary payor.
Additional Considerations
Be aware that per CMS guidelines, CareGuard cannot reimburse for copays or deductibles. For more detailed guidance, please refer to the CMS documentation on handling Medicare Set-Aside funds.
