How Do You Calculate a Medicare Set-aside?

Like many people, you may be wondering how a professional hired to perform the allocation will figure out how much money you will need to have in your MSA. Even though every case differs, four factors will determine the appropriateness of an MSA. For more information on how you calculate a Medicare set-aside, please keep reading, then contact our team today.

What four factors determine the appropriate amount of your Medicare set-aside?

To determine the amount of funds you should have in your account, an expert allocator will look at the following:

  • The personal injury settlement recovery amount
  • The full value of your case if you went to trial or arbitration
  • The amount allocated to future medical care, and
  • How much future Medicare-allowable medical treatment you will need over your lifetime

What goes into the calculation of the Medicare set-aside account?

The professional hired to perform the allocation will include items and services related to the injury otherwise covered by Medicare. They will calculate post-settlement treatment, prescription drugs and items, based on several different sources and factors, including, but not limited to, the following:

  • Applicable workers’ compensation fee schedules
  • Usual and customary charges
  • Actual charges, by reviewing claims payment and prescription drug payment histories
  • Last two years of treatment records
  • Medical bills, and
  • Facility and provider fees

What are the steps for calculating a Medicare set-aside?

Every expert allocator will employ a different method for calculating the funds you will need over your lifetime. Nevertheless, many such individuals follow these recommendations:

  • Determine if the injured plaintiff even needs a Medicare set-aside: The expert allocator will base this on the individual’s anticipated settlement amount, the potential cost of future related medical care and current Medicare status and eligibility.
  • Determine the appropriate allocation: An expert allocator will gather information about the beneficiary’s covered and non-covered medical needs.
  • Prepare for compliance: Plaintiffs may choose to self-administer their Medicare set-aside accounts, but self-administration could mean making critical accounting errors and improperly using funds. A professional administration firm can handle the process instead to ensure proper use and management.
  • Implement the most cost-effective funding solution: Interested parties may fund Medicare set-aside accounts in a number of different ways. A professional administration firm can explain each option to determine which will best serve the needs of the individual beneficiary.

How can a professional administration firm help calculate a Medicare set-aside?

An experienced settlement planner can assist claimants in determining how much money to set aside in their accounts so that the plaintiffs do not over-fund them. Medicare will review each submission independently of other submissions for claimants with the same injury and age.

Contact MSA Meds

For help in ensuring you receive the appropriate amount of funds, contact MSA Meds today.