An MSA, or Medicare set-aside account, is an account used to pay for injury-related, Medicare-covered medical services and prescription expenses. That may seem simple enough, but a couple of caveats serve to complicate the concept of MSAs. In the absence of clear, concise information, myths have sprung up about MSAs. If you would like help debunking these myths about MSAs, please continue reading, then contact our team today. Here are some questions you may have:
Does Medicare cover everything?
Medicare does not cover a variety of medical treatments and modalities, making it difficult for people to understand what they can and can’t receive coverage for with their settlement funds. For instance, some inaccurately believe that you can use the MSA to fund anything that the insurance company previously paid for. In fact, the injured individual may need to find alternatives and ensure that Medicare covers their treatments. An experienced administrator may prove invaluable by offering discount networks for non-MSA services and medications, thereby limiting out-of-pocket costs.
Do MSAs cover the same items universally?
Each individual who settles their claim has unique needs. The MSA outlines the specific injury/injuries covered, treatments, prescriptions, etc. and includes the associated funding amounts. Whether Medicare covers treatment for an injury often relies heavily on the ICD 9/10 Code as well as the CPT code billed. A treatment code may be covered for one diagnosis code but not another. Understanding diagnostic codes, service codes and Medicare coverage determination is often too complicated for lay individuals. A professional administrator is experienced with these issues and will ensure that only covered services are paid from the MSA Account.
What happens if my medical treatment needs change?
Contrary to popular belief, medical treatment needs do, in fact, change over time. Physicians may add new medications and/or change the dosages. Additionally, you may need surgery to treat the work-related injury. Treatment plans can and do change. The general rule for MSAs is that you may pay for treatment that was not projected in the CMS Determination as long as the treatment is related to the injury and otherwise covered by Medicare.
Quite often, individuals believe that if they do not spend the MSA funds for a time period, they can use the funds on unrelated items. This is incorrect. You can’t use unspent MSA money for recreational spending money; you can only use the funds for “injury-related” and “Medicare-covered” services. If treatment needs decline there is a one-time opportunity to request the amount of the MSA be lowered by CMS.
Contact MSA Meds
Leveraging discount providers and pharmacies offered by reputable professional administrators can be key to weathering unexpected changes in treatment regimens. The best way to extend and protect your MSA funds is by hiring MSA Meds to professionally administer your MSA Account. MSA Meds is here to help you protect your Medicare benefits. Contact MSA Meds today.