Medicare Set Aside
MEDICARE SET ASIDE (MSA)
One of the issues that has been in the forefront in many workers’ compensation claims is the use of the Medicare Set Aside Trust or MSA. This usually arises when the injured worker is currently eligible for Medicare benefits or will be eligible within 30 months.
The general policy behind this requirement is to avoid the injured worker from shifting the burden of medical expenses from the private insurance carrier or worker to the Medicare system. In the appropriate case, prior to any settlement the parties will “guestimate” the expected future medical expenses and submit the proposal to Medicare (CMS or Center for Medicare Studies) for approval. This process normally takes about 4-6 weeks.
While it may be desirable for the parties to settle a case without an MSA, if a case settles without an MSA in place when one is required, the injured worker is left without the protection of Medicare benefits if the person becomes a Medicare beneficiary.