Medicare Set-Asides

Medicare Set-Aside Blog on April 30, 2008
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The Medicare Secondary Payer (“MSP”) program is not limited to conditional payments made prior to settlement or to an arbitrary group of workers’ compensation settlements between $25,000 and $250,000, depending on Medicare entitlement. The MSP statute simply states that Medicare may not make payment for the medical treatment where another party is responsible. In most states, workers’ compensation laws provide for lifetime medical treatment of work injuries; therefore, by law, Medicare should never make payment for any medical treatment related to a work injury, even after the claim is settled. In most liability settlements, an injured party is compensated for past as well as future medical treatment, once again alleviating the need for Medicare coverage of that injury. Because most everyone will become entitled to Medicare, either by attaining retirement age, receiving Social Security Disability Benefits for a certain period of time, or under special circumstances such as developing end stage renal disease, Medicare has exposure in nearly every insurance claim settled. Hence, all parties to any insurance settlement should be aware of the need for a Medicare Set-Aside allocation.

    MEDVAL     1-888-SET-ASIDE (1-888-738-2743)

    Medicare Set-Aside Allocation/Arrangement Recommendations
    Submissions to Centers for Medicare and Medicaid Services
    Post-Settlement Administration
    Pharmacy Benefit Management

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