If you’re a Medicare beneficiary and are about to receive a workers’ compensation or liability settlement to pay for future injury-related expenses, you are required by law to consider Medicare’s interests. Failing to do so can mean losing your benefits.
By law, Medicare is known as a secondary payer. That means that when an injured person has certain types of insurance coverage, those insurance companies are first responsible for paying for related medical expenses. If those companies do not cover the full cost of services, Medicare may then become responsible for the balance of payment.
Medicare beneficiaries risk a denial of coverage for future medical expenses if the Centers for Medicare and Medicaid Services determines that Medicare’s interests have not been appropriately considered. A Medicare set-aside is one way to ensure that much-needed coverage is not negatively affected.
Establishing a Medicare Set-aside
My comprehensive settlement planning firm, Milestone Consulting, has helped many people establish Medicare set-asides (MSAs). When this is the best option for a Medicare beneficiary, we take a streamlined and systematic approach to ensure adequate Medicare compliance and protection.
Our recommended four-step process is as follows:
- Determine if a MSA is legally necessary based on the individual’s anticipated settlement amount, potential cost of future related medical care, and current Medicare status and eligibility.
- Determine the appropriate allocation. An expert allocator will gather information about the beneficiary’s covered and non-covered medical needs.
- Prepare for compliance. Plaintiffs MAY choose to self-administer their MSAs. However, self-administration could mean making critical accounting errors and improperly using funds.
- Implement the most cost-effective funding solution. MSAs can be funded in different ways. An expert can weigh these options for the best tax-saving benefits, flexibility, and cost.
By taking a logical, documented approach to the MSA process, individuals can comply with Medicare secondary payer laws, and their future medical needs and Medicare eligibility will be protected.
Feel free to contact Milestone if you or your client is about to receive a settlement and is a Medicare beneficiary. We can get you on the right path toward Medicare compliance.
A West Point graduate where he served as captain and military aviator, John Bair continues his commitment to our country through his efforts within the settlement planning industry. He has represented families of victims lost in the Flight 3407 crash, offered pro bono services to the families of 9/11 victims and drafted the first consumer protection bill for plaintiffs (H.R. 3699).