Medicare Set-Aside Arrangements

If you have been injured in an accident and have been told by your treating physician that you will likely need future care, it is important that you understand what that means for your personal injury case. For those victims who are on Medicare, will be a Medicare beneficiary within 30 months, or have a “realistic expectation” of becoming a Medicare beneficiary due to Disability Benefits, it is important that you keep in mind the concept of a Medicare Set-Aside Arrangement (MSA).

The purpose of a MSA is to avoid shifting the financial burden to Medicare if you are being compensated for future care in your personal injury case. For example, if part of your $300,000 settlement is in consideration for medical care you need in the future, Medicare should not be on the hook later to pay for that care. The Centers for Medicare and Medicaid expect that you have placed some portion of your settlement into a specially designed Trust for future medical care.

Things To Consider For An MSA

When determining whether your case might fall within the conditions for a MSA, here are some criteria to consider:

Are you a Medicare beneficiary (due to age or disability benefits) and your total settlement value is greater than $25,000?

Is there a “reasonable expectation” that you will become a Medicare beneficiary within 30 months of the settlement date and the anticipated settlement amount for future medical expenses, disability, and lost wages is expected to be greater than $250,000.

A “reasonable expectation” occurs when:

a) you have applied for Social Security Disability

b) you have been denied Social Security Disability Benefits but plan to appeal

c) you are in the process of appealing a denial of Disability Benefits or re-filing for Disability Benefits

d) you are 62 years and 6 months old

e) you have End-Stage Renal Disease (ESRD) but do not yet qualify for Medicare based on ESRD.

Things To Consider For An WCMSA

If you are settling a Workers’ Compensation case and a portion of the settlement is to pay for future medical services related to the workers’ compensation injury, you will need to do a separate analysis to determine if a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is necessary. 

These issues can be complicated but the purpose is simple. The Centers for Medicare and Medicaid Services (CMS) want to make sure the victim is not burden shifting future medical payments to CMS. If you receive money for future medical care, that money may need to be put in a special Trust to ensure that future care is paid for with this money rather than CMS money. To avoid future penalties, being denied future benefits, or facing other civil actions taken against you, contact our office for a free consultation to determine if you need an experienced attorney to assist with your case. Most personal injury victims have a much better financial outcome if they have legal representation and hiring an attorney can be critical for someone who is receiving benefits from Medicaid or Medicare.

Witt Law Group is a personal injury / auto accident law firm based out of Kitsap County Washington. We have offices in Bremerton, Poulsbo and Gig Harbor for your convenience. If you have any questions about an MSA, please give our personal injury lawyers a call.