What expenses can I use my Medicare Set Aside account on?

The injured party can use their Medicare Set-Aside (MSA) funds on Medicare-approved expenses directly related to their injury. Your MSA account can only be used to pay for medical treatment or prescription drugs that are both related to your workers' compensation injury and would be covered by Medicare. This applies even if you're not yet a Medicare beneficiary.

Allowed expenses for MSA funds

All allowed expenses must be primarily for medical care rather than general health or cosmetic purposes and must be related to the injury that necessitated the MSA. Expenses that are usually allowed include:

1. Medical care: Doctor visits, hospital services, surgeries, and lab work.
2. Prescription medications: All medications prescribed by a physician.
3. Durable medical equipment and supplies: Crutches, wheelchairs, blood sugar test kits.
4. Physical therapy and rehabilitation services.
5. Hearing aids and batteries.
6. Dental care: Cleanings, fillings, extractions, dentures, and orthodontia.
7. Vision care: Eye exams, glasses, contact lenses, and laser eye surgery.
8. Mental health services: Therapy, psychiatric care, and addiction treatment.
9. Preventive care: Screenings, annual physicals, and immunizations.
10. Qualified long-term care services.
11. Travel expenses essential for medical care (gas mileage, parking, tolls).

What expenses are not allowed to be paid from an MSA account?

It's important to note that MSA funds cannot be used for any other expenses other than the Medicare-approved items and services connected to the injury. Misuse of funds can lead to penalties or affect future Medicare coverage.

1. Health insurance premiums (with certain exceptions like COBRA, long-term care insurance, or health insurance while receiving unemployment benefits)
2. Cosmetic procedures that aren't medically necessary (such as cosmetic surgery, teeth whitening, etc.)
3. General health products like vitamins, supplements, or toothpaste (unless specifically prescribed for a medical condition)
4. Non-prescription medications (except insulin and some OTC items with a doctor's prescription)
5. Expenses incurred before your MSA was established
6. Gym memberships or fitness programs (unless specifically prescribed by a doctor for a medical condition)
7. Expenses reimbursed by other insurance
8. Funeral expenses
9. International medical treatments (in most cases)

Managing MSA expenses effectively

If you are self-administering your MSA, it’s important to carefully review healthcare provider bills to ensure they are only for items and services that are both related to your workers' compensation claim and covered by Medicare before paying. Proper management of your MSA funds ensures that once your account is appropriately exhausted, Medicare will pay for future treatments.

Managing MSA expenses yourself can be complicated. We’re here to help – with CareGuard, you'll never touch a medical bill, and our experts will file any necessary Medicare Set Aside reporting on your behalf.

Additional Guidance on MSA Accounts

For more detailed information about managing and using MSA funds in accordance with Medicare guidelines, consult the WCMSA Reference Guide.