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| Milestone Consulting, LLC

If you’re about to receive a settlement recovery in your injury lawsuit, you may have heard the sudden arrival of this substantial income could impact your eligibility to receive Medicare benefits.

With this issue in mind, many plaintiffs work with a settlement planner to establish a Medicare set-aside (MSA), an amount of money that’s literally put aside to protect a beneficiary’s future Medicare eligibility. In a nutshell, an MSA is a voluntary arrangement that demonstrates a good-faith effort to fund future care without relying solely on Medicare. By establishing an MSA, plaintiffs are indicating to the Centers for Medicare Services (CMS) that they are not trying to extract undue funds from the Medicare system.

Do I need an MSA with my settlementHowever, not all settlements require an MSA. Although they are the CMS’s preferred method for overcoming primary payer issues (more on that topic here), all MSA arrangements are voluntary. Here are two examples of scenarios in which an MSA is often not recommended:

  1. The plaintiff is Medicare-eligible, but no amount of the settlement is meant for future medical care.
  2. Only past damages and wages are being recovered in the settlement.

As settlement approaches, consult with a qualified planner to determine whether an MSA is advisable. For example, this option might be the best approach if payments are made for expenses related to the injury and the settling parties have considered future medical costs that would typically be covered by Medicare. No matter the scenario, a settlement expert will be able to point you in the right direction.

Your planner said an MSA is the best route to protect your Medicare eligibility — now what? How much money to set aside is the next critical question. The following four factors determine the appropriate MSA amount:

  1. The settlement recovery amount,
  2. The full value of your case if you went to trial or arbitration,
  3. The amount allocated to future medical care, and
  4. How much future, Medicare allowable medical treatment will be needed over your lifetime.

Maybe you haven’t yet spoken to a settlement planner, but your attorney suggested establishing an MSA with some of your settlement recovery. No matter your unique situation, it’s important to research your options and rights to make the most informed decision possible. Your eligibility for Medicare benefits might depend on it.

Feel free to contact Milestone Consulting if you are a Medicare beneficiary and are about to receive a settlement. We are a comprehensive settlement planning firm vastly experienced with establishing MSAs. Our experts can answer your questions and, if an MSA is the right option for you, we can work together to avoid any disruption in your Medicare compliance.




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


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