How to Avoid a Medicare Set Aside: The Ultimate Guide for Workers’ Compensation Settlements

How to avoid a Medicare Set Aside and get the most out of your workers’ comp settlement? Learn the best strategies in this article.
How to avoid a Medicare Set Aside and get the most out of your workers’ comp settlement? Learn the best strategies in this article.

If you are involved in a workers’ compensation case, you may have heard of a Medicare Set Aside (MSA).

An MSA is a portion of your settlement that is allocated for future medical expenses related to your work injury.

The purpose of an MSA is to protect Medicare’s interests and prevent it from paying for medical services that should be covered by your settlement.

However, an MSA can also reduce your net settlement amount and complicate your settlement process.

So, is there a way to avoid an MSA and still comply with the Medicare Secondary Payer (MSP) laws?

In this article, we will show you how to avoid a Medicare Set Aside and get the most out of your workers’ compensation settlement.

What are the criteria for an MSA?

According to the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, an MSA is recommended when:

– The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000; or
– The claimant has a reasonable expectation of becoming a Medicare beneficiary within 30 months of the settlement date and the total settlement amount is greater than $250,000.

These are only guidelines, not requirements, and CMS has the discretion to review any case that involves future medical expenses.

Therefore, even if your case does not meet these criteria, you may still need an MSA to protect Medicare’s interests.

How to avoid an MSA?

There are several strategies that you can use to avoid an MSA, depending on your situation and the nature of your case. Some of the most common strategies are:

  • Close out future medicals: This means that you agree to give up your right to future medical benefits for your work injury in exchange for a lump sum payment. This way, you can avoid an MSA and have more control over your medical care. However, this also means that you will be responsible for paying for all your future medical expenses out of your own pocket, and Medicare will not cover them until you exhaust your settlement funds.
  • Use a structured settlement: This means that you agree to receive your settlement in periodic payments over a certain period of time, instead of a lump sum. This way, you can reduce the present value of your settlement and avoid triggering the MSA thresholds. However, this also means that you will have less flexibility and liquidity with your settlement funds, and you will still need to account for future medical expenses in your settlement amount.
  • Go to court or to the work comp board: This means that you agree to have a judge or an arbitrator decide your case after a hearing on the merits of your claim. This way, you can avoid an MSA and rely on the judicial decision to protect Medicare’s interests. However, this also means that you will have to go through a lengthy and costly litigation process, and you will have no guarantee of the outcome of your case.

What are the risks of avoiding an MSA?

Avoiding an MSA may seem like a good idea, but it also comes with some risks and challenges. Some of the potential risks are:

  • Disregard of the settlement: If CMS determines that your settlement is an attempt to shift the responsibility for your future medical expenses to Medicare, it may refuse to recognize your settlement and deny your Medicare claims until you spend down your settlement funds.
  • CMS not bound by non-submitted MSA: If you decide to allocate an MSA amount in your settlement without submitting it to CMS for approval, CMS may not be bound by your MSA amount and may require you to pay more or reimburse Medicare for any payments made on your behalf.
  • Right of recovery: If Medicare pays for any medical services that should have been covered by your settlement, it has the right to recover those payments from any entity that received a portion of your settlement, such as you, your attorney, or your insurer.

ALSO READ

Conclusion

An MSA is a way to protect Medicare’s interests and comply with the MSP laws when settling a workers’ compensation case that involves future medical expenses.

However, an MSA can also reduce your net settlement amount and complicate your settlement process.

Therefore, you may want to avoid an MSA and use other strategies to settle your case.

However, you should also be aware of the risks and challenges of avoiding an MSA and consult with an experienced attorney before making any decisions.

By doing so, you can avoid a Medicare Set Aside and get the best possible outcome for your workers’ compensation settlement.

Spread the love

Leave a Comment