Medicare set-asides (MSAs) for Workers’ Compensation

Group 152

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Contributor Aaron P. Frederickson has written the following post:

Medicare set-asides (MSAs)cause headaches for attorneys and injured claimants alike. However, problems in the future—including the loss of Medicare benefits—can be avoided by following some simple guidelines when self-administering a MSA.

  • Once MSA funds are received, the claimant/Medicare beneficiary should immediately place all designated funds into an interest bearing account. The claimant/Medicare beneficiary should be the sole beneficiary of this account.
  • The principal and interest from the MSA account should be utilized to pay only for medical expenses related to the injuries closed out by the settlement AND only for services or treatment covered by Medicare.
  • All funds from the MSA should be exhausted before Medicare resumes payment of medical expenses related to the medical conditions or injuries closed out under the settlement.
  • If the settlement agreement calls for the claimant/Medicare beneficiary to make payment for medical care and treatment to medical providers under a fee schedule, every effort should be made to receive care in this manner.
  • Medicare has vague guidelines as to who can self-administer a MSA. Current informal requirements prescribe that the administrator speaks/reads English and not have a conservator or guardian appointed for their care. Self-administration is cost-effective!
  • Make sure that all receipts are saved from funds used under the MSA. Be sure to follow Medicare’s accounting guidelines. Medicare publishes forms for the required accountings, which can be found at, and are also included once they approve a MSA.

If you have questions on MSA administration or compliance with the Medicare Secondary Payer Act, consultation with a Medicare-compliance professional is recommended.

Aaron P. Frederickson, Esq., MSCC