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What is a Medicare Set-Aside (MSA)?

A Medicare set-aside (MSA for short) is a mechanism sometimes used in settlement when Medicare might have an interest in your workers’ compensation case.  Generally, funds from settlement create the Medicare-set aside account.  An injured worker then uses those funds after settlement to pay for medical treatment for the work injury.

I do not intend this blog to be a complete description of the rules of when and how to use a Medicare set-aside.  That information and advice should come from an attorney familiar with the specifics of your case.

Instead, I intend this blog to provide general information about what a Medicare set-aside is and to explain some situations where you should consider one.

Remand decisionWhat are some of the situations where I might consider setting up a Medicare set-aside?

If you are already a Medicare beneficiary at the time your case settles, you will need to consider strongly a Medicare set-aside.

You are a Medicare beneficiary if you have received a Medicare card.  Two of the most common reasons injured workers qualify for Medicare before settlement are:

  1. They reach 65 years of age
  2. They qualify for Social Security Disability and get disability benefits for two years

People who have applied for Social Security Disability benefits or will soon be 65 also need to strongly consider Medicare Set-Asides.

How do most Medicare Set-Aside accounts work?

The settlement document often specifies how the Medicare set-aside will be funded.  Many times, the workers’ compensation insurance company funds the Medicare set-aside with a lump sum.  Sometimes, they also purchase an annuity that makes annual payments.

Often, the settlement document contains the amounts that will go into the MSA.  One issue that often comes up is whether that amount may change if Medicare requires a higher amount.  Depending on the amount of the MSA and your Medicare status at the time of settlement, Medicare may or may not agree to review the MSA.

Sometimes, MSAs are self-administered.  Other times, you or the insurance company hires a professional administrator to manage the money in the MSA.

Whoever administers the MSA generally has responsibility for making sure they use the MSA funds properly.  A failure to do so could result in penalties from Medicare.

Why would I want to set up a Medicare set-aside?

MSAs can provide you with a safety net.  At the time that your case settles, you do not know the exact amount of what your future medical treatment will cost.  So, it is possible that you might not have enough money to pay for future medical treatment.

Many people wonder why they cannot just use Medicare to pay for treatment after settlement.  The reason they cannot is the Medicare Secondary Payor (MSP) Act.  This law makes Medicare secondary to workers’ compensation for payment of medical treatment.

People often solve this problem by considering Medicare’s interests when they settle their workers’ compensation cases.  A Medicare set-aside provides one way to consider Medicare’s interests.Man with injured back walking with cane

If the MSA is properly prepared and used and adequately considered Medicare’s interests, then Medicare should provide a safety net once the MSA is used up.  This provides protection for injured workers when they settle their cases.  But they have to make sure that they do everything right.

If my settlement amount is lower, can I just not consider Medicare’s interests?

Failing to consider Medicare’s interests could be risky.  You might find that Medicare refuses to pay for any future treatment related to your work injury.  If Medicare mistakenly pays for some treatment for your injury, they might also come after you to collect that money plus additional damages.

Do I have to use a Medicare set-aside to consider Medicare’s interests?

No.  A Medicare set-aside is not the exclusive way to consider Medicare’s interests.  You have other options to consider.  The best option for you definitely will depend on the specific facts of your case.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
Amazing! Jason and his team were very helpful and had the best communication by far. Walked me though every step with great detail and had answers for any question I had. They handled my case better then I could imagine, it was a weird case and they stayed on top of it and kept me updated every step of the way! Highly recommend this Team! Thanks so much to Jason and his Awesome team!-Brittney
China JonesChina Jones
18:58 08 Feb 22
I absolutely love this group of attorneys, when I was at my lowest they did everything they could to help me get justice for my injury. I believe if I were to have never picked my phone up and called the amazing group that helped me I definitely would not have received my idea of rights. If you have an issue and are just not sure please understand that they will help you, stay in contact, answer any question you have, and for sure get you the justice you deserve I thank them from the bottom of my heart and I will definitely refer them to anyone who has been hurt because they most definitely care about their work and clients.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
21:14 02 Jan 22
If you must get a lawyer involved, you’d do well to work with Jason Perkins and his team at Perkins Studdard Law.They were thorough in gathering information and in sharing all the steps in the workers comp process specific to my case. Jason and the team were responsive to my bevy of questions and concerns.I appreciated the informative videos and consultations provided by Jason over video meetings and multiple phone calls.I hope I’m never injured on the job again. However, if I am and if my employer responds as my previous employer did, I’ll contact Perkins Studdard Law immediately to handle the case.
Dana BessDana Bess
23:57 10 Dec 21
Everyone at Perkins Studdard was kind and professional. They were always extremely responsive and answered all questions that I had and followed up to make sure I had an understanding of what was going on along with emailing videos to explain every step of my case so I would know what to expect and be prepared. Jason is a very genuine person and I trusted him with my case. He answered so many questions for me even before I retained him as my WC lawyer. I highly recommend him and his associates at Perkins Studdard.

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Jason Perkins

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