FAQs on Medicare Set Asides in Worker’s Compensation Agreements

Posted on Monday, October 5th, 2015 at 2:25 pm    

North Carolina and also Federal Law requires that some North Carolina worker’s compensation settlement agreements contain an MSA (Medicare Set-Aside) account.

What is an MSA Account?

Many employees who settle their claims will continue to need medical assistance. The cost to pay for this assistance has to be considered.  The costs related to the work injury will be paid by the employer or the insurance carrier. When the employee reaches that age of 65, or if the employee has been on Social Security Disability for 24 months, Medicare will pick up the medical payments for the non-work related items.

Why Does Medicare Get Involved in Worker’s Compensation Cases?

The Medicare Set-Aside account makes sure Medicare isn’t paying more than it needs too. Federal Law says when you’re settling your worker’s comp claim, you cannot “double dip.” This means you cannot get a lump sum for future medical costs in your workers comp settlement, and then turn around and ask Medicare to pay for those same future medical costs. Medicare is funded by the US taxpayers.

So to avoid this “double dipping,” it is sometimes required that you make sure that Medicare’s interests, (and also the American Taxpayer’s interests) are being properly protected. In certain cases, Medicare will even have to approve the amount in the Set-Aside account before it can become part of the settlement.

In worker’s compensation agreements that require it, money that is set-aside to pay for the medical care related to the work injury.

How Does the MSA Work?

An MSA is a projection/prediction of the employee’s future medical treatments and the costs to pay for those treatments. It includes doctor visits, medical tests, surgeries and medications. It does not include long-term care such as in-home nurses.

If the medical care is of the type that ordinarily Medicare pays for, that money received for that portion of the settlement is often put into a special separate account called a Medicare Set-Aside (MSA) Account. The employee will use the money from this account only to pay for the medical bills related to the work injury until the account is spent in full. Of course, this may take many years.

Then, after the account is exhausted, Medicare will begin to pay for the bills – but only if it can be documented that the funds in the account were used properly and all the reporting and record keeping rules were met.

An experienced North Carolina worker’s compensation lawyer will let you know if an MSA account is required and if so, how to navigate the rules.

North Carolina Lawyer Joe Miller Understands Medicare Set-Asides

Many Workers Compensation settlement agreements include a Medicare Set Aside. The settlement agreement and Medicare should pay for the medical expenses the worker will have after the date of the settlement agreement. To make sure the Medical Set Aside is done correctly, workers should use a knowledgeable worker’s compensation lawyer. North Carolina Joe Miller has that experience. He has been helping injured workers for more than 25 years. Call Attorney Joe Miller at 888-694-1671 or submit his online form.