What Is A Medicare Set Aside (MSA)?
There are special rules that apply for when an MSA is required on a case. These rules can be complicated and have changed, and are changing, over time. Whether one is need in your case is not always clear. If you case is entering into Stipulations With Request for Award or going to Trial, an MSA is not needed. The reason is because in those circumstances, you will be retaining your right to receive medical care from the worker’ compensation insurance company. We are only concerned about an MSA when the parties have agreed to settle by Compromise and Release Agreement (total closure of your case including closing the right to get medical care).
The goal of an MSA is to protect Medicare (tax payers) from paying for medical treatment which was caused by the industrial injury. It used to be that injured workers settled claims for less than they were “worth” because they knew they could use their Medicare to pay for the work related treatment. This was a win for the insurance company because they paid less than they should. This was not fair to the taxpayer, who covered this cost.
Medicare (CMS) now requires that the insurance carrier either prepare a MSA or hire a company to prepare a MSA report in certain circumstances. The MSA report calculates how much work injury medical treatment we expect you would use with your Medicare over your lifetime, if you were to use it. Medicare does not pay for all types of treatment or medications. Therefore, a skilled attorney will need to determine if your case requires an MSA and look over the MSA to determine how much more money should be provided by the insurance company to make sure all of the future costs (Medicare and Non-Medicare covered costs) are included in the settlement. Don’t settle by simply agreeing to receive only the MSA amount, especially if the carrier indicates you don’t need MSA approval from Medicare before getting the settlement approved by the Workers’ Compensation Judge. There are a lot of pitfalls during this process and many options. Seek help. Your right to use Medicare for your work injury is in jeopardy if you are not in compliance with the spending of the MSA.
Another option for staying in compliance with Medicare, it to get professional administration of the MSA. The insurance company will usually pay for a professional administrator (Medivest, Ametros, etc) to receive the MSA money, at the time of settlement, and pay your medical bills, keep receipts, and report to Medicare once per year, as required. This takes away the worry of staying in compliance and protecting your right to use Medicare if you spend the entire MSA. (See Medicare Compliance FAQ on our website)
In addition to an attorney, you may often want to work with a structure settlement broker to maximize your settlement and protect yourself. Structure brokers are free to you because they are generally paid by the annuity companies. Do not rely solely upon the carrier’s broker since they will generally only have the carrier’s interests in mind. Work with your attorney to hire a broker that is skilled in workers’ compensation matters since brokers from other areas of law will not be aware of the all of the issues to look out for.
