3 Things attorneys may not know about Medicare Set-Aside allocations

Cynthia Bourbeau, RN, CRRN, CCM, CNLCP®
Founder & President – Medical and Life Care Consulting Services, Inc.

The Centers for Medicare Services defines Medicare Set-Aside (MSA) allocations as financial agreements that allocate a portion of a workers’ compensation, medical malpractice or personal liability settlement to pay for future medical services related to the injury, illness or disease. These funds must be depleted before Medicare will pay for related treatment.

We work with attorneys to evaluate a person’s future medical needs and recommend an amount that should be set aside for future medical care. Once the government approves this amount, the administrator of the MSA fund uses the funds to pay for medical care related to the plaintiff’s injury. For example, if there is a settlement case for $6 million, and $2 million of that was approved for medical and care costs, that amount is put aside for future medical costs.

1. Medicare Set-Aside allocations not required in all states…yet

Medicare requires Medicare Set-Aside allocations in many states. The conditions under which an MSA is required vary by state, and attorneys need to be prepared. While an MSA is not required in all states, the federal government requires that Medicare’s interests are considered in all settlements for those people who are Medicare beneficiaries or likely to become a beneficiary in next 30 months.

MSAs have been used for years in workers’ compensation cases, and the government has extensive reporting and monitoring rules in place. MSA law is complicated and constantly changing, reinforcing the need for an experienced life care planner.

2. Who is responsible to ensure an MSA is completed?

When MSA allocations are mandated, it is the attorney who is responsible to ensure one is completed and the money is put aside. Medicare can collect against insurance carriers, the client, their legal counsel and their advisors—any counsel involved in a settlement—because of workers’ compensation, liability or no-fault settlements when the financial interests of Medicare are not protected with an MSA.

3. We will improve your MSA claims, settlement outcomes and trust arrangements

Our life care plans present concise standards of practice, data analysis, research, clear chronologies and evidence-based plans for current and future costs to maximize wellness throughout the patient’s lifetime.

We work with attorneys across the country to develop life care plans and MSAs, complete the Medicare paperwork, and make the necessary notifications. We offer best practices with a clinical approach for formulating MSA allocations to remain compliant with Medicare.

If you are an attorney specializing in medical malpractice, workers’ compensation or liability claims, contact us today to learn how we can help you plan for your client’s future.