Medicare set asides can be a complicated and a difficult process to understand. When contemplating settlement of your case and a Medicare set aside is being discussed, there are several things that you, the injured worker, should consider.
1. Work comp related medical would be closed out forever.
Medicare set asides are only used in cases where the injured worker is either a Medicare beneficiary or has a reasonable expectation of becoming beneficiary within 30 months and, if the parties intend on closing out future medical expenses. If these factors have been met, then it is not necessary that a Medicare set aside by set up.
Essentially, a MSA or Medicare set aside is established to put a sum of money aside for future Medicare related expenses. The key to this is that it is not to be used for non-covered Medicare expenses. There may be items that the injured work needs, such as home remodeling, medical tools, medical accessories, etc. that if you close out your workers’ compensation related medical expenses you would not be able to use the Medicare set aside monies to pay for said items. Consequently, it is important to have an idea to what future needs you may have before closing out your work-related medical expenses in exchange for a Medicare set aside.
2. Administration of the Medicare set aside.
Because this is a lump sum of money that gets put aside, Medicare requires that every dollar be accounted for and used for work-related Medicare expenses before Medicare will pay any future related expenses. Consequently, this requires a detailed accounting of every bill, prescription, etc. before Medicare will pay anything. The good thing is that there are services out there that will do the accounting; however, just like any provider they charge a fee.
It is important to discuss this with the adjuster or attorney prior to settlement so that an administrator can be put on your case.
These are some helpful hints when exploring settlement which may necessitate a Medicare set aside. If you wish to discuss the matter with a Minnesota Workers’ Compensation lawyer who handles Medicare set asides, please feel free to contact our office to discuss your case during a free consultation.