When is an MSA Allocation Necessary?

There are two issues to consider when determining whether or not a Medicare Set-Aside Allocation is necessary in a given situation.

The first issue is whether or not the settlement closes future medical payments. In cases where the carrier will continue to cover the medical expenses associated with claimant's injury beyond settlement, a Medicare Set-Aside Allocation is not required. This is because Medicare has no expectation of incurring any costs if future medicals are remaining open. In cases where all future medical payments will be closed with the settlement, circumstances may arise that could expose Medicare to medical costs associated with claimant's injury.

The likelihood of Medicare having to pay for medical expenses associated with the claimant's injury can be reasonably determined by addressing the second issue, namely, identifying the claimant's eligibility or receipt of Medicare benefits and/or Social Security Disability Insurance. If the injured person is currently receiving Medicare benefits, a Medicare Set-Aside Allocation is necessary. Furthermore, The Centers for Medicare and Medicaid Services (CMS) wants to identify if there is any reasonable expectation that injured person will be receiving Medicare benefits in the near future, so if the injured person is at least 62.5 years old or if they have applied (or re-applied) for Social Security Disability Insurance, an Medicare Set-Aside Allocation is necessary.

For a clarification of the above, consult the following flow chart:

If you are unsure of the current Social Security or Medicare status of an injured person, Medivest can verify the Social Security Disability Insurance and Medicare status. Just fill out this simple form, and a representative will be on touch with you promptly.