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Can I spend my Medicare Set Aside money?


“Once your WCMSA account is set up, you can ONLY use it to pay for medical treatment or prescription drugs related to your WC claim, and ONLY if the expense is for a treatment or prescription Medicare would cover. This is true even if you are not yet a Medicare beneficiary (not yet enrolled in Medicare).” See Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements, sec. 4. “A WCMSA allocates a portion of the WC settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare (“Medicare covered”).” See Workers’ Compensation Medicare Set-Aside Reference Guide, v3.1, sec. 3.0.

Funds from an MSA cannot be utilized for anything other than treatment related to an underlying injury otherwise covered by Medicare. If the funds are spent on other things, there may be issues with respect to Medicare coverage. “ related to medically necessary services and prescription drug expenses for the WC settled injury or illness, Medicare will deny all WC-injury-related claims until the WCMSA administrator can demonstrate appropriate use equal to the full amount of the WCMSA.” See Workers’ Compensation Medicare Set-Aside Reference Guide, v3.1, sec. 17.3.

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