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What is my obligation to Medicare?

Your obligation to Medicare is to protect its interest as a secondary payer. If you are covered by Medicare or are Medicare-eligible and have a workers’ compensation claim, your medical expenses associated with that claim should not be paid by Medicare. Medicare is always a secondary payer. Your obligation is to ensure primary payers like your employer’s insurance carrier fulfill their obligations, pay medical bills that are their responsibility, and not have those bills paid by Medicare. This obligation continues after a case settles if an element of the settlement is future medical expenses. After the claim settles, you step into the shoes of the workers’ compensation carrier and become the primary payor obligated to properly pay your medical bills until the funds intended for future medical care are exhausted. You can contract that responsibility to a professional management company.

If you settle with a Medicare Set Aside, according to CMS guidelines, You:

  • Are only allowed to spend your MSA funds on Medicare-covered treatments related to your injury.
  • Must place MSA funds in a separate, interest-bearing bank account
  • Must keep copies of bills & receipts
  • Must report all expenses you used your MSA funds on to CMS each year and in the case your funds run out
  • Must only pay the state fee schedule or "usual and customary" pricing for treatments & prescriptions

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