A Medicare Set-Aside (MSA) is a document that specified future injury-related medical needs and associated costs. Only Medicare-covered expenses are identified and costs are based upon what would ordinarily be paid by Medicare within the beneficiary's state jurisdiction.
Based upon the MSA projection, part of a settlement is "set-aside" in order to pay for the costs of future care which would ordinarily have been paid by Medicare.
Medicare's interests must always be considered before settling a worker's compensation injury claim if a Medicare beneficiary. For those not currently receiving Medicare benefits are obligated to establish a Medicare Set-Aside if there is a reasonable expectation of Medicare enrollment within 30 months of the settlement date and if there is an anticipation of receipt of a total settlement of more than $250,000.
A Medicare Set-Aside allows parties to satisfy the requirements of the Medicare Secondary Payer (MSP) by considering Medicare's interests when settling future medical expenses.
Review medical records
Verify eligibility for Social Security and/or Medicare benefits
Obtain treating provider recommendations and research applicable standards of care and clinical practice guidelines
Identify future medical needs