Medicare Set Aside Arrangements - St. Louis Injury Lawyer

By James Hoffmann  Jun. 18, 2020 2:49p

Health insurance in the United States is a complex topic with multiple interacting parts. Take national insurance programs, such as Medicare and workers' compensation insurance covered through third-party companies. Although you may get compensation for your injuries through the federal program, the law is very strict when it comes to shifting the burden of injury claims to Medicare.

If your injury falls under workers' compensation and you are expected to receive Medicare benefits in the future, then you may have to create a special trust called "Medicare Set Aside" also known as MSA.

Here's what you need to know about MSA, your legal obligations, and your rights.

How Medicare Set Aside (MSA) Works

When it comes to work injuries or any other type of personal injury claims for that matter, Medicare is the secondary payer. That means that the federal health insurance program will kick in only after your primary source of payment (in this case, the workers' compensation insurance) has been exhausted.

If it is determined that you will receive Medicare, then a portion of the settlement will be set aside into a special MSA account. This money will be used to cover your medical expenses. Medicare will start paying your medical bills only after these funds have been exhausted, ensuring that the money has indeed been used for injury-related expenses.

As you would expect, the regulations are very strict when it comes to Medicare payments. The money can only be spent on treatments and procedures covered by Medicare and at a rate approved by the federal program.

When Is MSA Needed and How Is It Calculated?

If you get injured on the job or are hurt because of someone else's negligence, then Medicare may become a secondary payer in case the primary insurer doesn't have the necessary funds to cover all your medical expenses.

It's not unusual for workers' compensation claims to require an MSA as the cost of medical treatment in America can be extremely high.

Workers' compensation insurance companies usually work with third-parties specialized in estimating what the treatment would cost if Medicare paid it. They look at your medical history to determine the treatment you may require over the course of your life and how much that would cost.

It's a Complex Process

On paper, the process of getting compensated for your work injuries looks as simple as filling a claim and waiting to receive your benefits. However, when you look at what goes on behind the scenes, you realize that this is an incredibly complex system that involves different parties.

Your St. Louis workers compensation lawyer can help you understand how the system works and what you need to look for to ensure you will receive a fair settlement.

Call 24/7 for a FREE consultation :: (314) 361-4300