What you need to know about Medicare set-asides in South Carolina workers’ compensation

Imagine finally settling your workers’ compensation case, only to discover unexpected medical bills down the road. For many workers in South Carolina, understanding the role of Medicare Set-Asides (MSAs) can prevent this scenario and safeguard their future medical needs.

At Smith Jordan Law, our Greenville workers’ compensation lawyers believe in the power of clear, honest communication and the importance of diligent preparation. Let’s dive into Medicare Set-Asides, why they matter, and how they are crucial to your workers’ compensation settlement.

medicare set aside workers compensation

What is a Medicare Set-Aside?

A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA, or MSA) is a financial arrangement designed to allocate a portion of a workers’ compensation settlement for future medical expenses that would otherwise be covered by Medicare. This ensures that Medicare remains the secondary payer and that the funds are properly used for medical treatments related to the work injury.

Why are Medicare Set-Asides important?

MSAs protect Medicare’s interests and ensure that settlement funds are appropriately spent on future medical needs related to the workers’ compensation claim. Failing to establish an MSA when required can result in Medicare refusing to pay for medical expenses, potentially leaving the injured worker with out-of-pocket costs.

When is a Medicare Set-Aside required?

In South Carolina, an MSA is typically required in two main scenarios.

Workers aged 65 or older

An MSA is necessary if you are a Medicare beneficiary (usually 65 or older) and your workers’ compensation settlement exceeds a certain threshold. The Centers for Medicare & Medicaid Services (CMS) requires an MSA for settlements over $25,000.

Workers expected to become Medicare-eligible

If you are not yet a Medicare beneficiary but expect to become one within 30 months of the settlement date, and the total settlement amount is expected to exceed $250,000, an MSA may be required.

Establishing a Medicare Set-Aside

Step 1: Determine the need for an MSA

Assess whether your settlement meets the criteria for requiring an MSA. This involves understanding both your current Medicare status and your potential future eligibility.

Step 2: Calculate the MSA amount

The MSA amount must be carefully calculated to cover all future medical expenses related to the workers’ compensation injury. This involves thoroughly reviewing medical records, treatment plans, and projected costs. Consulting with medical and legal professionals is crucial to ensure accuracy.

Step 3: Submit for CMS approval

Once the MSA amount is determined, the proposal must be submitted to CMS for approval. CMS will review the proposed amount to cover future medical expenses adequately.

Step 4: Fund the MSA

After approval, the MSA must be funded as part of the workers’ compensation settlement. The funds are typically placed in an interest-bearing account and can only be used for medical expenses related to the work injury.

Using the Medicare Set-Aside

The funds in an MSA can only be used for specific medical treatments and services related to the workers’ compensation injury. Proper documentation and reporting of expenditures are essential to comply with CMS guidelines.

Legal support for Medicare Set-Asides

Navigating the requirements for an MSA can be complex. At Smith Jordan Law, we provide the following support.

Expert guidance

Our experienced attorneys guide you through the process, ensuring that all necessary steps are followed and the MSA is properly established.

Accurate calculation

We work with medical professionals to project future medical expenses accurately and determine the appropriate MSA amount.

CMS submission

We handle the submission process to CMS, including preparing and submitting all required documentation.

Compliance and reporting

We assist in managing the MSA funds, ensuring compliance with CMS guidelines, and properly reporting expenditures.

Relevant South Carolina statutes

Understanding the legal framework for workers’ compensation in South Carolina is essential. The South Carolina Code of Laws Title 42, Workers’ Compensation, outlines workers’ compensation regulations. Specific settlements and medical expenses statutes include South Carolina Code of Laws Section 42-9-10.

Want to know more about Medicare Set-Asides? Call us.

Medicare Set-Asides are a critical component of workers’ compensation settlements for individuals who are current or future Medicare beneficiaries. Ensuring an MSA is properly established protects your rights and future medical benefits. Contact us today for expert legal support if you need assistance or have questions about MSAs.

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