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Medicare Set-Aside Administration Comparison

Chose the right service for your case.  Generally, Medicare Set-Aside Professional Administration should be considered in settlements where the total future medical expenses is expected to be an average to sizable sum. Also, if the claimant’s injury is catastrophic, Medicare Set-Aside Professional Administration should be considered.  The Self-Administration Kit is most appropriate for simple settlements with smaller future Medicare allowable medical expenses.

Medicare Set-Aside Administration Comparison Chart

 No Service UtilizedSelf-Administration KitProfessional Administration
When To Use
Recommended if claimant has a catastrophic injury
Recommended if claimant has been ruled physically or mentall incompetent
Recommended if the claimant has a life situation that puts the MSA funds at risk
Recommended for small to medium-sized cases where the claimant is physicall and mentally compentent to administer their own MSA funds
Benefits
May be funded with a structured annuity
Access to experienced Medicare Set-Aside professionals
Access to discounts on pharmaceuticals and durable medical equipment
All accounting, reporting, bill re-pricing and bill payment is performed for the claimant
Negotiated fees for medical services, future surgeries, hospitalizations and pharmaceuticals
Guidance is available to the claimanat on how to pay their own medical bills
The claimant is their own advocate
Administrator is an advocate for the claimant
Protection
Reduces E&O | malpractice exposure
Shows intent to protect Medicare's interest
Guarantees protection of Medicare's interest
Reduced claimant exposure to Medicare benefit loss risk
Funds guaranteed to be spent according to federal guidelines

The right Medicare Set-Aside administration option is dictated by more than just the size of the MSA.  The claimant’s life issues can sometimes create a possible Medicare Secondary Payer compliance issue.  For instance, if the claimant has been ruled incompetent by a judge, or if there are financial issues that may place the Medicare Set-Aside funds in jeopardy, Medicare Set-Aside Professional Administration may be the better option, even for smaller Medicare Set-Asides.  A professional fiduciary is able to make objective decisions about how money should be properly spent, and is not encumbered by emotional factors.

Self-Administration is an excellent choice when the claimant is competent and their medical needs are expected to be minimal.  If the claimant is good at managing a checkbook and keeping funds separate, they may just need a bit of assistance interpreting their medical claims, and re-pricing them.  Also, if the claimant is responsible for their own care and their injury does not impair their ability to perform simple tasks such as opening mail, reviewing documents, using a calculator or writing checks, self-administration could be a reasonable option.