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What Are MSAs?
Medicare Set-Aside (MSA) Allocations are Federally mandated accounts that provide necessary funding to cover future injury/illness related Medicare allowable medical expenses for qualified individuals.
Why Are MSAs Required?*
To shift the burden of responsibility from Medicare as the primary payer to the rightful primary pay coverage when applicable. This would make Medicare the secondary payer.
* From 1981 to 1998, Medicare paid $43 Billion in benefits that were the responsibility of Workers Compensation. (SOURCE: GAO Report)
How Are MSAs Funded?
MSAs are created via the establishment of a funding account (either lump sum, structured annuity or combination) with a proper funding mechanism and administration oversight.
Who Qualifies For MSAs?
A claimant who:
• Is Medicare recipient at the time of settlement.
Or
• The claimant has a "reasonable expectation" of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.
When Are MSAs Needed?
Prior to settlement agreement.**
** Centers for Medicare and Medicaid Services (CMS) should be consulted regarding adequacy of proposed MSA funding in order to provide protection from future (post settlement) expenses. Pre-settlement conditional payments made by Medicare are subject to reimbursement.
Additional Services at an Hourly Fee Include:
• Catastrophic Case Management n Onsite Case Management
• Legal Nurse Consulting n Life Care Planning
• Vocational Case Management
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