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Medicare Set Aside

A Medicare Set Aside account is just an organized way to show Medicare that you took their interests into consideration at the time of settlement.

A Medicare Set Aside account is a portion of of your settlement set aside to cover all future injury-related medical expenses for you that would normally be paid by Medicare. When the Medicare Set Aside account funds exhaust, Medicare will step in as primary payor granted you have reported your use of the funds properly to Medicare and, of course, that you are enrolled in a Medicare plan.

When Do You Need a

Medicare Set Aside

?
A

A Medicare Set Aside is never required, but many parties to a settlement choose to specifically put together an allocation report showing items that are related to the injury and would be covered by Medicare.

The report is called the Medicare Set Aside. Medicare Set Aside's can be submitted to Medicare for review and approval if they are significant to meet Medicare's review thresholds; in any event, the process of review and approval is voluntary. Getting approval just means Medicare has validated the amount set aside is accurate.

How Ametros Works with

Medicare Set Aside

Accounts

We are the industry leader in helping injured parties manage their Medicare Set Asides after settlement.

When you settle the medical portion of a claim and you are eligible for Medicare, a Medicare Set Aside Account can be established. If a case settles with a Medicare Set Aside, the you have a responsibility to report injury-related purchases annually to Medicare, in order to protect your Medicare benefits. Ametros is the industry leader in managing Medicare Set Aside funds, providing full professional administration as well as self-administration tools.

CMS requires that all Medicare Set Asides be administered following these main six guidelines:

  1. Funds must be held in an interest-bearing account
  2. Use the fund only for treatments related to the injury
  3. Use the fund only for Medicare–covered expenses
  4. Pay according to the appropriate fee schedule
  5. Prepare and submit annual accounting report to CMS
  6. Maintain line item detail for the duration of eligibility

If you or your attorney does not comply with this complex list of requirements, you risk being denied your benefits by Medicare.

Our Services

CareGuard

Medicare Set Aside

Professional Administration Service

This service helps parties with a Medicare Set Aside account remain compliant with the Medicare Secondary Payer Act. Services include capturing all bills, processing payments and reporting regularly to the member and CMS in full compliance with Medicare regulations. When your case settles with a Medicare Set Aside, you have a responsibility to report your purchases annually to Medicare, in order to protect your Medicare benefits. CareGuard handles all annual reporting and also guides you through what purchases can and cannot be made out of the account.

careguard card
  • Extending Medicare Set Aside Funds: On average members save 62% on provider bills, and 28% on expenses such as durable medical equipment, medical treatment, and prescriptions. Member carry over these savings to the next year, helping make their settlement funds last as long as possible.
  • Freedom to Treat: Members can see any doctor or provider, without Utilization Review.
  • Support: 24/7 access to our team of Care Advocates.
  • Technology: A state-of-the-art online portal where members can review the status and total savings of their CareGuard Medicare Set Aside Account.
  • Reporting: With CareGuard, all reporting is handled and members are compliant with Medicare guidelines.

Amethyst

Medicare Set Aside

Self-Administration Tool

When self-administering a Medicare Set Aside, you are responsible for producing all of the annual reporting that Medicare requires. Historically, little to no savings were made available to individuals self-administering their Medicare Set Aside. With Amethyst, members have access to a vast network of savings and 24/7 access to our Care Advocate team. Additionally, Amethyst provides you with the tools needed to compile your annual report to Medicare listing all their expenses. All the while, the funds remain in your personal bank account.

amethyst card
  • Savings: An average annual savings of 21% on your projected Medicare Set Aside expenses.
  • Technology: A state-of-the-art online portal where members can chat, view spending trends and savings amounts.
  • Freedom to Treat: Members can see any doctor or provider, without Utilization Review.
  • Support: 24/7 access to our team of Care Advocates.
  • Reporting: Medicare compliance support.

careguard

Professional Administration Service

CareGuard was created with one goal in mind: making the post-settlement process seamless. We do this through our combination of member support and professional administration services.

CareGuard is the first fully automated solution for professional administration which gives the member 24/7 insight into their spending and savings trends. Our team is experienced working with settlements that are both structured into annuities or paid out in a lump sum. We also manage funds for both Medicare Set Asides and other medical allocations..

careguard card
  • savings

    Extending Medicare Set Aside Funds: On average members save 62% on provider bills, and 28% on expenses such as durable medical equipment, medical treatment, and prescriptions. Member carry over these savings to the next year, helping make their settlement funds last as long as possible.

  • treatment

    Freedom to Treat: Members can see any doctor or provider, without Utilization Review.

  • support

    Support: 24/7 access to our team of Care Advocates.

  • technology

    Technology: A state-of-the-art online portal where members can review the status and total savings of their CareGuard Medicare Set Aside Account.

  • reporting

    Reporting: With CareGuard, all reporting is handled and members are compliant with Medicare guidelines.

amethyst

Self-Administration Tool

Amethyst is designed to allow you to remain in complete control of your funds, while ensuring a seamless process for both the member and facility providing services.

With Amethyst you have the ability to link your settlement funds directly to a personal bank account. The Amethyst platform functions by managing transactions, funds, and ensuring funds are available to support charges in question.

amethyst card
  • savings

    Savings: An average annual savings of 21% on your projected Medicare Set Aside expenses.

  • treatment

    Freedom to Treat: Members can see any doctor or provider, without Utilization Review.

  • support

    Support: 24/7 access to our team of Care Advocates.

  • technology

    Technology: A state-of-the-art online portal where members can chat, view spending trends and savings amounts.

  • reporting

    Reporting: Medicare compliance support.

Still Have Questions?

Speak to one of our experts to get more information about how Ametros can help with your Medicare Set Aside.

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