What is a Medicare Set-Aside Account?

When a person is involved in an accident that is due to negligence, it is an unfortunate reality that there are many financial burdens that stem from these matters. After a settlement is made in a workers’ compensation or personal injury liability case, the amount of it that is set-aside for medical care is required to be put into a certain account. This is known as a Medicare Set-Aside Account or an MSA Account. Continue reading below to learn more about the important information regarding these accounts.

What is an MSA Account?

A Medicare Set-Aside Account is a financial agreement that results from a workers’ compensation or personal injury claim. Essentially, the funds from a settlement are “set aside” in this account in order to pay for the claimant’s future costs relating to medical treatments and services. Only when the funds are depleted will Medicare begin to pay for the injured individual’s qualified medical expenses. However, this is only as long as the individual followed all the rules and regulations that are required. 

MSA Rules and Regulations

There are many restrictions on how the money in an MSA account can and cannot be spent. The rules mandate that the account holder only pays for medications and procedures that are covered by Medicare. In addition to this, they only pay the approved price for each bill. By law, MSA account holders are required to keep a detailed record of their expenditures on an annual basis. These should be reported to the Centers for Medicare and Medicaid Services (CMS). If the account holder fails to manage their account properly, pay more than the approved amount for a service, or pay for non-allowable expenses, they may risk future entitlement to Medicare benefits.

Am I Qualified for an MSA?

CMS guidelines state that it will renew claims proposals in the event of the following circumstances:

  • The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000 
  • The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the duration of the settlement agreement is expected to be greater than $250,000

What Happens When the MSA Funds are Done?

When the funds in a Medicare Set-Aside account have been depleted, a final audit will be performed on all expenditures. In the event that the funds were used properly, the injured individual should receive Medicare benefits for expenses that are related to the claim.

Contact MSA Meds

MSA Meds understands the ins and outs of the Medicare system and can save injured parties from being unprepared for their future medical treatment. Our team of professionals are proud to aid individuals in protecting their eligibility for Medicare. If you need assistance opening and managing a Medicare Set-Aside Account, contact MSA Meds today to discuss your situation.