Medicare Set-Aside

In today’s environment, proper evaluation of medical expenses is a significant factor in the effective resolution of claims. Both past and future medical expenses must be considered, particularly where Medicare is involved. Currently, Medicare takes the position of a secondary payer in cases where there is another culpable party, such as an employer and its workers’ compensation insurance carrier or a liability insurer, as set forth in the Medicare Secondary Payer Act. 42 U.S.C. §1395y and 42 C.F.R §411:20, et al.

The Medicare Secondary Payer Act (MSP) applies across the board to workers’ compensation, no-fault and liability actions. The same includes actions governed under the Federal Employees’ Compensation Act, the Federal Coal Mine Health and Safety Act of 1969, the Longshore and Harbor Workers’ Compensation Act and the Jones Act.

The purpose of the Medicare Set-Aside arrangement (MSA) is to provide funds to the injured party to pay for future medical expenses that would otherwise be covered by Medicare, otherwise known as “qualified medical expenses.“ If the injured party incurs qualified medical expenses that exhaust the anticipated MSA amount, Medicare will then pay for any excess allowable expenses. By establishing a Medicare Set-Aside Account, parties to a settlement are protecting Medicare’s interest and complying with the Medicare Secondary Payer Act.

Since at least 2007, the 10 Regional Offices of Medicare have had the discretion to review and approve liability MSAs. Some have exercised this option, while others have opted not to review such plans, but have repeatedly noted that parties must still ensure Medicare’s interests are accounted for as secondary (rather than primary) payer. Atlas Settlement Group is available to discuss submission in the various regions, our significant experience in handling liability MSAs, and the specifics of individual liability matters.

Medicare’s demands can cause confusion and uncertainty in settling claims. It is important that you entrust a professional company with the job of handling your Medicare needs.