FAQs

Medicare Set Asides


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What is a Medical Cost Projection?

Purpose and Coverage

While both MCPs and MSAs involve funding for medical expenses, their purposes differ. An MSA is specifically for Medicare-covered services related to a particular injury. In contrast, an MCP is assigned for medical expenses that Medicare does not cover or that are unrelated to the injury.

Flexibility and Management

MCPs, sometimes known as "Non-Qualified" medical expense accounts or Medical Custodial Accounts when managed by professional administrators, offer more flexibility. They do not have Medicare reporting requirements and can cover a wider range of treatments.

Post-Exhaustion Payment

One key distinction is what happens when funds run out. With an MCP, if funds are depleted, Medicare does not automatically step in to cover expenses, unlike with an MSA.

Final Thoughts on Medical Cost Projections

For those settling claims that require prediction of future medical expenses beyond standard Medicare coverage, considering a Medical Cost Projection can be beneficial. MCP accounts are advantageous for their flexibility and ability to manage non-Medicare eligible medical costs. For more complex details, refer to specialized legal or financial professionals.

For further understanding, it may be helpful to consult additional resources or legal professionals regarding MCP specifics and implications in settlement agreements.

Can I spend my Medicare Set-Aside money?

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 Medicare Set-Aside?

What is a Medical Cost Projection?

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How can Ametros help?

Ametros’ CareGuard service supports individuals in efficiently managing their settlement funds. With CareGuard, the MSA funds are securely held in an interest-bearing account under the injured party’s name. Ametros acts as the custodian, overseeing all aspects of fund management.

Benefits of CareGuard Service

  • Professional Administration: CareGuard takes care of everything for the injured party, ensuring hassle-free fund management.
  • Ease of Use with the CareGuard Card: The injured party gets a CareGuard card, functioning like a traditional insurance card, allowing them to avail of group purchasing discounts at doctors or pharmacies.

Simplified Medical Payments and Compliance

  • Streamlined Bill Payments: CareGuard handles all medical bills for the injured party, ensuring Medicare compliance by managing all required reporting.
  • Flexibility in Choosing Healthcare Providers: The injured party can select any doctor or pharmacy without the need for utilization reviews.

Dedicated Support Team

Ametros offers a team of Care Advocates ready to assist injured parties in coordinating their care, ensuring they receive the best possible service and support.

Additional Information

For more detailed insights into how Ametros and CareGuard services operate, please refer to the WCMSA Reference Guide.

Can't find the answer you were looking for?

Our team of experts is here to help answer any questions you have about Medicare Set-Asides, workers' compensation settlements, professional administration, and more.
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Get your questions answered by an expert. Scheduling a consultation is quick and easy.
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