MSA (d)(4)(A)

A Medicare Set Aside Trust is used for workers’ compensation settlement cases when the claimant has qualified (or will qualify) for Medicare. The purpose of the trust is to assure Medicare that the claimant’s medical bills will be paid in accordance with the commuted value approved by the Centers for Medicare and Medicaid Services (CMS).

Medicare will not cover a worker’s compensation claimant’s future injury-related medical expenses following a settlement until the amount of the settlement reasonably allocated to future medical expenses is spent on the claimant’s future injury-related medical expenses, for which Medicare would otherwise pay.  These regulations require that a worker’s compensation settlement must give reasonable consideration to Medicare’s interests as a secondary payer. If the settlement provides reasonably for the future medical bills, CMS will recognize it and extend coverage for the claimant’s injury-related care and treatment expenses in excess of the allocation.

Then, a Medicare Set-Aside arrangement must be submitted to and approved by CMS.  However, if the approved arrangement (such as a Medicare Set Aside Trust) is not administered according to CMS regulations, the claimant’s future Medicare benefits could be jeopardized. Properly administering an MSA Trust or Medicare Set-Aside Custodial Account is highly complex and typically administered only by professional fiduciaries.

Advocacy, Inc., was the first organization in the nation to offer this trust. We have the experience and knowledge necessary to administer your MSA Trust to the letter and help preserve your eligibility for future Medicare benefits.