Workers’ Compensation Medicare Set-Asides | What You Should Know

Workers’ compensation Medicare set-aside allocations are the primary means that are employed to protect the interests of Medicare concerning the future medical costs of its recipients. Pursuant to the Medicare Secondary Payer Statute (MSP) 42 U.S.C Section 1395 y(b) (2), Medicare may not make payment when payment has been made or can be reasonably expected to be made under a workers’ compensation plan. But what does all that mean for you? If you need help navigating this complex and time-consuming system, please read on for more detail, then you should please contact MSA Meds for attorney support for Medicare compliance to learn what you should know about workers’ compensation Medicare set-asides.

What are workers’ compensation Medicare set-asides?

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. These allocations are a projection of the cost of future medical treatment for the work injury that would otherwise be covered by Medicare. The WCMSA amount gets deposited into an interest-bearing account, with which the injured worker pays his or her bills related to the work injury.

What can a workers’ comp Medicare set-aside allocation be used for?

A workers’ compensation Medicare set-aside arrangement can be used for the injured worker’s future medical costs. These costs include but are not limited to:

  • Doctor’s visits
  • Hospital stays
  • Surgical procedures
  • Diagnostic tests
  • Laboratory studies
  • Physical therapy
  • Prescriptions
  • Some durable medical equipment

It can’t be stated frequently enough: These costs must always be related to the work injury. Otherwise, the client’s claim will be denied and the client will have to pay out of his or her own pocket.

What happens if a workers’ compensation Medicare set-asides account is exhausted?

If a workers’ compensation Medicare set-aside account is depleted and the injured worker still requires treatment, Medicare will begin paying bills for the work injury so long as the funds are properly spent and correctly reported to Medicare. We would not be doing our jobs if we did not advise you that you will still incur co-payments for treatment paid by Medicare.

Oftentimes, a workers’ compensation Medicare set-aside is not a true valuation of your future medical treatment. It is only the amount the Centers for Medicare and Medicaid Services is willing to accept as compliance with the Medicare Secondary Payer Statute. If you are an injured worker and need help calculating these additional expenses, contact MSA Meds today. The attorneys at MSA Meds stand ready to assist you, your doctors and your attorney in resolving your workers’ compensation claim so you can focus on treating your injuries. Do not suffer in silence. Give us a call today.