Once your Medicare Set-Aside (MSA) account is established, you can only use it to cover medical treatment or prescription drugs related to your workers' compensation (WC) claim. This spending is subject to Medicare guidelines, even if you're not yet enrolled in Medicare.
Is it illegal to spend Medicare Set Aside money?
No, however, spending MSA funds on non-covered items may lead to denied Medicare claims until proper usage of the full MSA amount is demonstrated. In other words: funds in an MSA are specifically allocated for treatments associated with the work-injury covered by Medicare. These funds can only be used for medical treatment or prescription drugs related to your workers' compensation claim.
Can I use MSA funds for over-the-counter medications and medical supplies?
Generally yes, but only if they're prescribed by a doctor or are directly related to your workers' compensation injury. Keep detailed receipts and documentation to prove the connection to your work-related condition.
What will happen if I spend my MSA funds on other expenses?
When funds from your MSA account are utilized incorrectly, Medicare may deny related claims. The account administrator must show appropriate use equal to the MSA amount for claim acceptance.
Detailed Guidance and Reference
For more detailed information, you can consult the Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements and the Workers’ Compensation Medicare Set-Aside Reference Guide.
What is a Medical Cost Projection?
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