When Is a Medicare Set-Aside Proposal Recommended?
As you likely know, Medicare is a complicated government program that amounts to the nation’s healthcare program for those over the age of 65. Medicare is funded by the taxes paid by workers and their employers and by the premiums the government deducts from social security payments. Medicare, however, is a secondary payer, which can seriously complicate both worker’s compensation claims and personal injury claims, and Medicare set-aside programs help to address these concerns. If you have a worker’s compensation claim and are facing issues related to a Medicare set-aside proposal, it’s time to consult with a seasoned Garden Grove worker’s compensation attorney who has extensive experience handling these challenging legal matters.
Medicare Secondary Payer Statute
Congress passed the Medicare Secondary Payer Statute in 1980 for the sole purpose of bolstering the Medicare Trust Fund’s financial integrity, and it clearly identifies Medicare as a secondary payer for all claims that proceed through the following forms of insurance:
- Worker’s compensation insurance
- No-fault insurance
- Liability insurance
- Self-insurance plans
- Employer group health insurance
As such, claimants tap these forms of coverage – the primary payers – first, and any additional coverage they need will proceed through Medicare – the secondary payer. Medicare set-aside programs are designed to help protect Medicare from being depleted by claims that attempt to retrofit the coverage into a primary payer.
Medicare Set-Aside Proposals
Medicare set-aside (MSA) proposals are detailed reports that address the issue of the applicant’s anticipated allowable Medicare expenses related to the injury in question over the course of the applicant’s life expectancy. In other words, it’s very complicated. This calculation process affords an amount of Medicare that must be set aside in the course of the worker’s compensation or personal injury settlement process to ensure that the Medicare Secondary Payer (MSP) Statute is satisfied – in order for Medicare to avoid absorbing the financial burden. When a claimant in a personal injury or worker’s compensation claim is nearing the age of 65 or is already Medicare eligible, Medicare’s financial burden – as a secondary payer – must be considered, and this is where Medicare set-aside proposals come in.
When Is an MSA Proposal Recommended?
The Centers for Medicare & Medicaid Services provide little guidance when it comes to MSA proposals, which means that claimants are required to proceed with caution. There is, however, a pretest you can take to help determine if an MSA proposal is likely the right option for you. If either of the following applies, you’ll very likely need to address the matter of an MSA proposal:
- You have a worker’s compensation or personal injury claim, and you are currently eligible for Medicare.
- You have a worker’s compensation or personal injury claim, are 62.5 years old and are within 30 months of eligibility for Medicare benefits.
If you have already applied for Social Security Disability Insurance (SSDI) or you have an application pending, you’ll need to address the matter of whether or not there will be enough funds available after any medical liens have been resolved to support an MSA account. This is a challenging legal matter that calls out for the professional legal guidance of a savvy injury attorney
When Is an MSA Proposal Recommended?
A Medicare set-aside arrangement amounts to an agreement between you and Medicare that allows you to take a portion of your worker’s compensation or personal injury settlement and set it aside for expected future medical expenses that are covered and paid by Medicare. While a Medicare set-aside agreement is not required by law, failure to have one in place if you need it can be deemed non-compliant in relation to the Medicare Secondary Payer Statute and can leave you in a financial predicament.
When it comes to anything related to Medicare, proceeding with caution and employing best practices is a must, and a dedicated California injury attorney can help you with that.
You Need an Experienced California Injury Attorney on Your Side
If you have suffered an injury on the job or as a result of someone else’s negligence, it is a challenging situation all the way around. If you are facing concerns related to Medicare as a secondary payer on top of everything else, you can expect serious legal complications to arise. If you find yourself in this difficult situation, you shouldn’t wait to consult with a practiced Garden Grove worker’s compensation yattorney. The consequences of failing to protect yourself and your claim are too great to leave to chance.
