In workers’ compensation cases, a Medicare Set-Aside (MSA) is crucial to protect Medicare's interests under the Medicare Secondary Payer laws. An MSA allocates part of a workers’ compensation settlement for future medical expenses related to the work injury, which are covered by Medicare. This ensures that Medicare does not pay for medical costs that the settlement is intended to cover.
Essential Elements of a Medicare Set-Aside
Medical Allocation: The MSA includes a detailed list of Medicare-covered treatments and prescription drugs. This list specifies the frequency, duration, dosage, and costs for the claimant's lifetime.
Sum to Structure: The MSA can be funded as a lump-sum payment or through a structured annuity. This provides flexibility in managing settlement funds.
Administration: While beneficiaries can manage their MSA funds, using a professional administrator is highly recommended to ensure compliance and efficiency.
Why is a Medicare Set-Aside Important?
An MSA ensures that Medicare remains the secondary payer in work-related injury cases. It preserves Medicare funds by preventing them from being used for expenses covered by the settlement.
Additional Resources
For more detailed information on MSAs and their specific regulations, refer to the Workers’ Compensation Medicare Set-Aside Reference Guide, v3.1, particularly sections 19.2, 9.4.4-9.4.6, 10, and 5.0.
