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Text Box: Medicare Set-Aside

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Medicare Set-Aside

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. 

Purpose:

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. 

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