Video Series

Medicare Set-Aside Self-Administration Basics

Hello! My name is Melissa, and I’m here to help you understand how to manage the money from your medical settlement.

It’s a big achievement to finally get your settlement, but sometimes you’re left wondering how to manage the money you receive. Depending on your settlement documents, the rules around managing your settlement can be complicated. There are also a few common mistakes that you can make that you might not know about that could risk your future Medicare benefits.

A portion of your medical settlement could be specifically designated for medical expenses. This is commonly called a Medicare Set Aside, or MSA. When spending from your Medicare Set Aside, there are a few things to keep in mind. Medicare requires you complete an annual report which proves that you have used your funds only on Medicare-approved treatments that are specifically related to your injury.

You may be asking, what does Medicare have to do with my settlement? The purpose of an MSA is to ensure that Medicare, the United States’ federal health insurance program, doesn’t end up paying for these expenses that should have already been covered by your settlement funds. An MSA is typically included when an individual receives a workers’ compensation or liability settlement.

The amount of a settlement that is set aside for an MSA is negotiated during the settlement based on factors such as the injury, and your overall health, and more.
In order to properly manage your MSA, you should keep receipts of all transactions using those funds, so they can be included in your annual report. Medicare could deny future payment if you cannot show your injury-related funds were actually spent on your injury.

Now that you understand what an MSA is, in our next video we’ll go over how you can manage your MSA either by yourself, or with the help of an experienced MSA administrator.

Live worry-free knowing your future medical funds are taken care of with Ametros.

Live a happier, healthier life after settlement with Ametros.

Settle well, live well with Ametros.

Hello I’m Melissa at Ametros. In this video we’re looking at the differences between self-administering your MSA, and having a professional manage your account. To understand the differences we’ll look at two cases as examples. We have Barry who wants to manage his own money and Linda who decided to hire a professional administrator.

When Barry got his settlement he chose to self- administer his funds. Here’s what that looks like. Based on Medicare’s requirements, he had to place this funds in a separate interest-bearing account. This helps Barry keep his MSA money separate from his personal finances and makes it easier to track his expenses.

Next Barry created a comprehensive plan for managing his MSA. This included a budget for anticipated medical expenses, a system for prioritizing and allocating funds, and a strategy for handling unexpected costs. Barry has to review and adjust his plan regularly to ensure it still meets his needs over time.

One of the most crucial aspects of self-administration is recordkeeping. Barry maintains accurate records of all his MSA transactions, including receipts, invoices, and proof of payment. He documents the medical necessity of each expense and keeps his records organized and easily accessible. Barry can’t forget about annual reporting requirements. He has to familiarize himself with the deadlines and procedures for submitting reports to the centers for Medicare and Medicaid services, also known as CMS. Barry prepares and submits his reports accurately and and on time to avoid any compliance issues.

Part of managing Barry’s MSA funds is knowing which treatments and procedures are Medicare approved and considered related to his injury. He has to be cautious about over-the-counter medications, or alternative treatments that wouldn’t be approved by Medicare. When he has questions about what is covered, he uses medicare.gov to search for an up-to-date list of Medicare compliant treatments. When self-administering his MSA after settlement, it’s up to Barry to advocate for the treatments he needs. This includes finding his own discounts when available and not overpaying for treatments as he will now be considered a cash payer for these funds.

Now let’s look at the process Linda went through. Unlike Barry, Linda decided to go with the professional administrator that her attorney introduced her to during the settlement process. Here’s what that looks like.

Once Linda settled her case, her professional administrator called her. They provided an explanation of how her account works and what she could use it for, ensuring she had a clear understanding of its functions. To help with Linda’s injury related medical transactions, her professional administrator gave her a specialized card. This card, like an insurance card, was designed for her to use for all her medical transactions tied to her injury.

Linda never has to touch a bill on her own, as all bills are sent directly to her administrator for them to pay on her behalf using her MSA funds. Each of Linda’s bills has the advantage of network savings applied to it. Not only are these bills automatically paid, but they’re also recorded in an online portal for accurate tracking and reporting. This ensures that Linda’s financial obligations related to her injury are managed efficiently and accurately, keeping her benefits intact.

On an annual basis reports are prepared and submitted to CMS on Linda’s behalf. This ensures that all necessary documentation is kept up to date and submitted in a timely manner.

Linda has access to a dedicated team of Advocates who are readily available to provide assistance and answer any question she may have. Additionally she has access to a secure online portal. Through this portal she can view her transactions as well as any reports that have been previously submitted on her behalf. This provides her with full transparency and control over her funds.

The main difference between “self” and “professional” administration, is the amount of work and responsibility for you. CMS actually highly recommends professional administration. Whether you choose professional administration or self-administration, the most important thing is staying informed and compliant.

At Ametros we believe you shouldn’t have to worry about compliance – just focus on returning to health after settlement.

If you want to save money and live worry free after settlement, contact us at Ametros.

Settle well, live well, with Ametros.