A workers compensation medicare set aside arrangement wcmsa is a financial agreement that allocates a portion of a workers compensation settlement to pay for future medical services related to the workers compensation injury illness or disease. A medicare set aside account can be administered by the injured individual self administered or by a professional administrator.
However unlike workers compensation cases the centers for medicare and medicaid services cms has not issued precise guidelines on how medicares interests must be protected in liability cases.
Medicare set aside. A specialized company evaluates your future medical needs recommends an amount that should be set aside for future medical care and the government approves the amount. The goal of creating a msa is to set aside money from the settlement to cover those injury related medical expenses. Their attorneys workers compensation wc medicare set aside arrangement msa agents or consultants or claimants other appointed representatives.
According to medicare a medicare set aside msa account is a portion of an injury settlement set aside for all future injury related medical expenses that are covered and would normally be paid by medicare. Medicare set asides for personal injury liability medicare set aside accounts medicares interests must be protected in liability cases. These funds must be depleted before medicare will pay for treatment related to the workers compensation injury illness or disease.
A medicare set aside is a trust or trust like arrangement that is set up to hold settlement proceeds for future medical expenses. A medicare set aside account is a portion of of your settlement set aside to cover all future injury related medical expenses for you that would normally be paid by medicare. Federal law even holds liable anyone who shifts the burden to medicare to pay for future medical expenses related to an persons personal injury or workers compensation accident or.
The account administrator whether the individual custodian or professional vendor is charged with keeping accurate accounting records of all disbursements from the account. Heres the essential information you need to know about who qualifies for them how they work approved expenses etc. A medicare set aside account also known as an msa is an important component of the workers compensation payment landscape.
This guide reflects information compiled from all wcmsa regional office ro memoranda issued by cms from information provided on the cms website from information provided by. When the medicare set aside account funds exhaust medicare will step in as primary payor granted you have reported your use of the funds properly to medicare and of. When settling claims workers compensation insurance companies are under a great deal of pressure to protect the interests of medicare.
This is where the medicare set aside comes in.