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John Bair
John Bair
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Three Big Questions (and Answers) About Medicare Set-Asides

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If your injury lawsuit is about to reach settlement, you have likely heard this new influx of income could impact your eligibility to receive Medicare benefits.

To avoid disqualification, many plaintiffs have set up a Medicare set-aside (MSA), which demonstrates a good-faith effort to fund future care without relying solely on Medicare. Establishing an MSA protects Medicare’s interests while ensuring a settlement is as beneficial as possible.

At Milestone, we have helped hundreds of people determine whether they need an MSA and then establish the arrangements to comply with Medicare. If you think this is a step you’ll need to take, we can help you get started. Below are answers to three common questions.

How do I know if I need an MSA?

The U.S. Centers for Medicare & Medicaid Services' website offers helpful information about MSAs and more.

The U.S. Centers for Medicare & Medicaid Services’ website offers helpful information about MSAs and more.

You may need an MSA if you’re currently on Medicare and are in the midst of workers’ compensation claim or personal injury lawsuit. By law, Medicare is a “secondary payer” for costs related to an injury or illness suffered by a person involved in a workers’ compensation or liability lawsuit. In other words, Medicare does not have primary responsibility for covering medical expenses until other responsible entities pay first.

Parties primarily responsible for these payments may include those held liable for the victim’s injuries as well as group health plan insurance, liability insurance, no-fault insurance and/or workers’ compensation (if applicable), according to a guide published by the Centers for Medicare & Medicaid Services.

How is an MSA funded?

There are different funding options for MSAs, including funding with a lump sum or utilizing a structured arrangement. A structured arrangement requires an initial deposit and regular deposits over a certain period of time. After those funds are exhausted, Medicare will kick in and be the primary payer for further injury-related expenses during that designated period.

The initial setup of an MSA can be complex. Bank accounts must be established, health care providers must be notified, and claims must be properly paid and recorded.

Do I need a professional to administer my MSA?

Beneficiaries can either elect to self-administer Medicare set-asides or retain a professional administration firm to handle the process. They can also connect with certain companies that charge a small fee for a self-administration guide. The Medivest Medicare Set-Aside Self-Administration Kit, for example, provides the resources needed to self-administer a Medicare Set-Aside account and explains how to properly hold and disburse MSA funds.

The decision between self-administering or retaining professional assistance is one that should be made by consulting with an unbiased expert, such as your attorney.

At Milestone, our settlement experts review a person’s individual case and determine the best course of action. If you’ve received an injury settlement and are exploring MSA options, we can help you take the next steps to maintain Medicare eligibility.

 

About John Bair

John Bair has guided thousands of plaintiffs through the settlement process as co-founder of Milestone Consulting, LLC, a broad-based settlement planning and management firm. Milestone’s approach is comprehensive and future-focused. John’s team has guided thousands of clients by taking the time to understand the complexities of each case. They assess the best outcome and find the path that enables each client to manage their many needs. Read more about Milestone Consulting at http://milestoneseventh.com/.

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