A Medicare Set-Aside (MSA) is not mandatory but is a proactive measure to demonstrate that Medicare's interests were considered during a settlement. An MSA allocation report outlines items related to the injury that Medicare would cover. Submission to Medicare for approval is voluntary to ensure the allocated amount is accurate.
Understanding Medicare's Interests in Settlements
Under Section XVIII of the Social Security Act, interests of Medicare must be considered in injury settlements. Though not required, some parties might opt to create an MSA report detailing costs that Medicare would cover.
Voluntary Review by Medicare
Medicare offers to review these allocation reports when the injured party is, or soon will be, Medicare-eligible, and the amounts are significant. While Medicare review is voluntary, adhering to the following thresholds can make it beneficial:
- The claimant is a Medicare beneficiary, and the settlement exceeds $25,000.
- The claimant expects Medicare enrollment within 30 months from settlement and expects future medical expenses and disability/lost wages settlement to exceed $250,000.
Who Is Eligible for Medicare?
Individuals are eligible for Medicare after age 65 or if under 65 and receiving Social Security Disability Insurance (SSDI), with exceptions in certain cases.
For detailed insights about MSA processes and requirements, refer to guidelines or consult professionals experienced with the Social Security Act and related Medicare stipulations.
