If you have a structured settlement and use up all the money in your MSA account before your next annual deposit arrives, your next steps depend on your Medicare status.
Handling an exhausted MSA if you are a current Medicare beneficiary
If you are a Medicare beneficiary, you should send an attestation letter to the Benefits Coordination & Recovery Center (BCRC) stating that your account is temporarily depleted. You can then bill Medicare for any additional expenses related to your workers' compensation injury until your next annual deposit is received.
This creates a situation where you will have alternating primary payers: first yourself through the MSA, then Medicare while your account is depleted, and then yourself again when your account receives its next funding. This alternating payment responsibility can be confusing for healthcare providers. It's important to clearly communicate with them about when they should bill Medicare instead of expecting payment from your MSA account.
If you have MSA funds to pay part of a bill but not all of it, it’s recommended you ask healthcare providers to send the entire bill to Medicare rather than paying it yourself.
Handling an exhausted MSA if you are NOT a Medicare beneficiary
If you are not yet a Medicare beneficiary when your account is temporarily depleted, you will need to use other insurance to pay for workers' compensation injury treatments until your MSA receives its next deposit. If you have no other insurance coverage, you will unfortunately have to pay out of pocket for these treatments until more funds are deposited into your account.
If you are self-administering your MSA, you can find more information about attestation in Self-Administration ToolKit v. 1.7
We’re Here to Help
With CareGuard, you're never deal with a medical bill alone. If you have a Medicare Set-Aside, CareGuard ensures full compliance by handling all necessary reporting to The Centers of Medicare and Medicaid Services (CMS), giving you peace of mind.
CareGuard also simplifies your care-related payments. Just present your CareGuard card at your doctor’s office or pharmacy, and we’ll handle the rest.
Please note: While CareGuard streamlines the billing process, there may be situations where members are responsible for paying a bill directly. In such cases, members can submit the invoice for reimbursement, as outlined in the Member Agreement provided at enrollment.
