What is a Medicare Set-Aside (MSA)?

Описание: What is a Medicare Set-Aside (MSA)?
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According to the Medicare Secondary Payer Act, one way to show that Medicare's interests has been considered is to set aside a portion of the settlement for the injured person to use on their future medical expenses. This is known as a Medicare Set-Aside account or MSA. An MSA is an account that holds a portion of the total settlement to cover the injured person’s future medical needs that would otherwise be covered by Medicare.

This is usually done in two parts. First, an initial payment called the seed amount is set aside to cover the first two years of annual payments as well as the cost of one-time medical procedures needed within the first few years. The second part consists of annual payments to cover the injured person’s medical expenses over their designated life expectancy.

As you can see in this case example, the injured person will receive an initial payment of fifteen thousand dollars as seed money and will then receive four thousand dollars paid annually for a maximum of 25 years, if living. The amount proposed to fund an MSA can be submitted to the Centers for Medicare and Medicaid Services for approval. Under what conditions might this happen? When the injured person meets one of the following criteria:

When they are currently a Medicare beneficiary and their total settlement is $25,000 or greater, or
When they are reasonably expected to be eligible for Medicare within 30 months and their total settlement is $250,000 or greater.
An injured person is reasonably expected to be eligible for Medicare within 30 months if:
They are applying for Social Security Disability Insurance (called SSDI).
They have applied for SSDI, were denied, and are in the process of reapplying.
They are over 65 years of age and therefore eligible for Medicare, or
They will be on Medicare within 30 months, either due to disability or because they are within 30 months of turning 65.

Medicare Set-Aside accounts are an effective way to take Medicare's interests into account at the time of settlement.