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What is a Medicare Set-Aside and Do I need one?

by onJuly 08, 2015

Under federal law, some persons who receive a recovery because of an injury accident are required to “set aside” a percentage of their recovery for future medical expenses they will incur due to accident-related injuries. This requirement is known as the Medicare Set-Aside (commonly referred to as an “MSA”).

The people who are required to consider Medicare’s future interest, and set aside monies for future medical treatment when they receive a recovery from a liable third party, include:

  • Current Medicare recipients
  • Current Social Security Disability recipients
  • Those who will be eligible for Medicare benefits within 30 months of settlement or judgment
  • Those who have applied for Social Security Benefits and are awaiting a decision

If required to consider Medicare’s future interest, a review by a qualified “Set-Aside” specialist is necessary. The specialist will review your medical records, speak with your doctors about your future care needs related to the injuries sustained in the accident, and speak with you about your injuries and anticipated future needs. Once he/she has gathered this information, they are able to put together a projection of the cost of your total future medical expenses for accident-related treatment.

Once a projection is complete, the client will then be aware of what expenses they must pay for out of their recovery, as Medicare will not pay for any future medical expenses related to treatment of injuries sustained in the accident, for which the client has received a recovery. Ideally, the client will place the amount of the projection in a new interest-bearing checking account, and only use those funds to pay for future accident-related medical expenses.

The downside to Set-Aside accounts is that the money must only be used for future accident-related medical expenses, and cannot be used for any other purpose whatsoever. Even if the client feels that they have fully recovered from their accident related injuries, they cannot take the Set-Aside money out of the account. It must stay in the account until they have exhausted the funds paying for medical care or until they die. If the money is taken out for any other purpose, and additional accident related medical expenses are incurred, Medicare can deny payment for those expenses, leaving you with an unpaid medical bill.

The requirements regarding Medicare Set-Aside Accounts are very confusing and complicated. If you fall into the class of persons who are required to consider Medicare’s future interest and/or have an MSA, you need an attorney familiar with the process to assist you. The attorneys of Lafferty Gallagher & Scott have been working with MSAs and Medicare for years, and have the experience necessary to protect you and your future rights. If you have been injured in any type of accident, and must consider Medicare’s future interest, contact us today for a free initial consultation. Not only can we help you get the compensation that you deserve from the responsible party, we can help you make sure you comply with all health insurance laws and regulations to ensure that you get the maximum benefit you are entitled to.

The information contained in this blog post is general information, and should not be treated as legal advice. No attorney/client relationship exists between the reader and Lafferty, Gallagher &Scott, LLC without a signed Attorney Contract Agreement of Representation. Each case is unique and past results should not be treated as a guarantee of the results in your case.

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