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Medicare Set-Asides

Take Medicare’s Interests “Under Consideration”

The Medicare program pays medical expenses for the elderly and disabled. However, if those medical expenses are the responsibility of another party, Medicare will stop paying and will require reimbursement for payments already made. If you are settling a workers’ compensation or liability claim involving past, current or future medical expenses, you are required to consider Medicare’s interests as part of the settlement process. Failure to do so could jeopardize your current or future Medicare benefits, or worse yet, expose you, your attorney and even the insurance company/defendant to stiff fines or penalties. This is where a Ringler consultant can make a difference for you, combing through the details of complex compliance issues with an objective perspective.

Start With a Medicare Set-Aside (MSA)

The most prudent method for properly recognizing Medicare’s interests is through an approved Medicare Set-Aside (MSA) arrangement. The MSA details exactly how much money should be set aside out of your settlement funds to meet Medicare’s interests for the future medical portion of your settlement. MSA calculations can be quite complex and require extensive documentation. But once it is properly executed, an MSA provides everyone involved in the settlement confidence that Medicare’s interests have been considered.

Who Should Consider an MSA?

We recommend that Medicare’s interests be considered whenever settling a workers’ comp or third-party claim involving future medical benefits. The Center for Medicare and Medicaid Services (CMS) reviews MSAs if:

  • You are a Medicare recipient and your total settlement exceeds $25,000; or,
  • You are expected to become a Medicare recipient within 30 months of settlement, and your total settlement exceeds $250,000.

While CMS does not currently review third-party liability settlements involving future medicals, many insurance carriers and attorneys are looking at ways to ensure that Medicare’s interests are protected by using an MSA or finding another alternative to protect Medicare’s interest as part of the settlement.

Fund Your MSA With a Structured Settlement

Your Ringler® consultant has extensive experience and training in working with Medicare and can help you navigate an MSA in two important ways. First, we have access to experts in preparing an MSA. Second, we can show you how funding your MSA with a structured settlement is the best possible solution, usually providing you with more spendable dollars for your future needs.

Next Step?

A structured settlement with an MSA is a specialty of Ringler. Contact a Ringler consultant and get the ball rolling. Get it right and everybody wins.