How Do You Keep Your Benefits with a Medicare Set-aside?

For many injured plaintiffs, settlement comes as a relief. Unfortunately, if they do not take proper action, personal injury plaintiffs who are Medicare beneficiaries may lose their eligibility for benefits. For some, the solution to this issue is a Medicare set-aside. For more information on how to keep your benefits with a Medicare set-aside, please read on, then contact our team today.

Who qualifies for Medicare benefits?

As a government-provided health insurance program, Medicare assists certain people with hospital care, medical costs and other expenses. Qualifying beneficiaries include:

  • People aged sixty-five or older
  • Those younger than age sixty-five with certain disabilities, and
  • People of all ages with permanent kidney failure

Can I keep my benefits with a Medicare set-aside?

Yes, the whole point of a Medicare set-aside is to protect Medicare’s interests. A Medicare set-aside accomplishes this by relegating Medicare to secondary payer status in instances including, but not limited to, injuries covered under:

  • A workers’ compensation plan
  • No-fault insurance
  • An automobile or liability insurance policy or plan, including a self-insured plan
  • A structured settlement annuity:
    • Greater than $25,000 if you are a Medicare beneficiary at the time of settlement, or
    • Greater than $250,000 if you are not a Medicare beneficiary at the time of settlement but expect to enroll within thirty months of settlement
  • A group health plan, either held by you or as a dependent through a spouse or guardian:
    • Through an employer with twenty or more employees
    • Through an employer with one hundred or more employees, if the beneficiary is disabled, or
    • During the first thirty months of treatment for end-stage renal disease

Will you still keep your benefits after your Medicare set-aside account runs out of funds?

If your set-aside funds run out and you exhausted the funds properly according to Medicare’s guidelines and you reported your use of funds properly, Medicare will step in as the primary payor for your future medical expenses related to the specific injury. Once Medicare steps in to begin covering you for treatments related to your injury, they will treat you like any other Medicare beneficiary and subject you to corresponding co-pays, coinsurance and deductibles.

How do you comply with Medicare to ensure you keep your benefits?

In order to retain your Medicare benefits upon exhausting your set-aside account, you must meet all six of the following guidelines:

  1. Holding the funds in an interest-bearing account
  2. Using the fund only for treatments related to the injury
  3. Using the fund only for Medicare-covered expenses
  4. Paying according to the appropriate fee schedule
  5. Preparing and submitting annual accounting reports to Medicare, and
  6. Maintaining line item detail for the duration of your eligibility

Contact MSA Meds

This might sound like a lot to deal with, so contact MSA Meds today for assistance.