MEDICARE SET-ASIDES

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WHAT IS A MEDICARE SET-ASIDE (MSA)?

When a claimant, receiving medicare benefits, is involved in a physical injury claim, a Medicare Set-Aside (MSA) is often implemented to ensure future medical costs, related to the injury, are covered. Medicare will begin generating payments for the claimant’s qualified medical expenses again once the MSA account is exhausted. A Medicare Set-Aside (MSA) is funded by all, or a portion of, a claimants’ settlement funds into a special account using either a lump-sum payment or through a series of structured settlement annuity payments. Funding an MSA with a structured settlement annuity is the most cost-effective, way to ensure Medicare’s interest is taken into account and required funds for future costs are achieved.

HOW IS IT DETERMINED?

There are a few factors that help determine how much money is needed to properly fund an MSA.

 

Here are a few of the most common to consider:

 

  • The estimated total cost of the claimants future medical expenses (determined & recommended by medical experts).

  • Statements from the claimant’s physician(s)

  • The claimant’s current and pre-existing medical history

  • The claimant’s life expectancy

  • The claimant’s current treatment plans

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FUTURE MEDICAL EXPENSES CAN INCLUDE:

  • Diagnostic testing

  • Durable medical equipment (i.e. back, knee or neck braces, etc.)

  • Follow-up care (i.e. rehabilitative services, physical therapy, etc.)

  • Home modifications (i.e. wheelchair ramps, etc.).

  • Inpatient or outpatient surgery

  • Medication management

  • Mental health treatment

  • Nursing home expenses

We look forward to walking you and your client through the MSA process.