Frequently Asked Questions

How long does it take to get a Medicare Set-Aside (MSA)?

MSA opinion letter prepared by us takes approximately three weeks. CMS approval takes approximately two to three months.

Why do I need a Medicare Set-Aside (MSA)?

The workers’ compensation insurance carrier needs an MSA to set aside funds to ensure that the insured’s anticipated future medical expenses are covered by the settlement and that the burden of the expense of the insured’s medical expenses does not fall solely on Medicare. By setting aside this money and obtaining approval of the amount and the arrangement from CMS (Centers for Medicare and Medicaid), the insurance carrier protects itself against the possibility of Medicare looking to it for payment in the future.

When do I need a Medicare Set-Aside (MSA)?

The workers’ compensation insurance carrier needs an MSA when (a) the settlement amount is over $250,000.00 in total and the insured is receiving social security disability benefits and expects to be on Medicare within thirty months of the settlement date, or (b) the insured is already on Medicare (if settlement exceeds $25,000.00).

What is a Medicare Set-Aside (MSA)?

This is an arrangement through which the workers’ compensation insurance carrier allocates an approved amount of money aside from the settlement of the claim (which can be structured and/or monitored in a number of different ways) to cover future medical expenses of an injured worker that would otherwise be processed by Medicare. In order to determine the amount of money to set aside, the insurance carrier would hire an independent company, such as CompEx, to review the insured’s medical records, pay screens, adjuster’s notes and correspondence in order to calculate an allocation amount commonly referred to as MSA. The report submitted to the insurer will include a summary of the set aside and the recommended amount.