SECONDARY PAYER
Medicare Set-Asides
What Is A Medicare Set-Aside (MSA)
A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), Liability Insurance Medicare Set-Aside (LMSA), and a No-Fault Insurance Medicare Set-Aside (NFMSA) allocates a portion of the settlement to cover future medical services related to injury, illness, or disease. MSAs anticipate future medical costs for services, equipment, supplies, and prescriptions covered by Medicare. The MSA allocation must be depleted before Medicare will pay for treatment related to the injury, illness, or disease. The MSA determines the amount from the settlement that should be “set aside”.
Overfunding an MSA does not help the person with an injury and has potential to hinder negotiations during settlement.
When is an MSA needed:
- The claimant is a Medicare beneficiary, and the total settlement amount is greater than $25,000.00; or
- The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00