When your Medicare Set-Aside (MSA) funds are exhausted, Medicare will begin to pay for covered items related to your injury, provided that you have properly managed and reported your MSA spending to Medicare. Additionally, you must be enrolled as a Medicare beneficiary. If these conditions are met, Medicare covers you just like any other beneficiary, including the applicable co-pays, coinsurance, and deductibles.
Conditions for Medicare to Step In
Proper Management of MSA Funds: If your MSA funds are depleted according to Medicare’s guidelines, and you've reported your spending correctly, Medicare will become the primary payer for your future medical expenses related to the injury.
Requirements to Ensure Coverage
To qualify for Medicare to cover your injury-related medical expenses after your MSA is exhausted:
- Enrollment in Medicare: You must be enrolled during an enrollment period.
- Correct Management of MSA Funds: Adhering to Medicare’s rules for managing your MSA is crucial.
Failure to correctly manage and report your MSA funds may result in a denial of coverage for injury-related care. Incorrect handling might jeopardize your future Medicare benefits.
Steps if Coverage is Denied
If your care is denied, you must replenish your MSA account for any unaccounted expenses and correct reporting to Medicare. It may be helpful to consult a professional administrator for assistance in managing your MSA effectively.
For detailed information about the rules and proper management of your MSA, consider referring to the WCMSA Reference Guide.
