Medicare Set-Asides: How Do You Know Your MSA is Enough?
Medicare Set-Asides (“MSAs”) are not a legally required tool. But they have significant value in protecting funds that will pay for an injured-person’s post-settlement, future medical care. These funds are necessary because 42 USC 1395y makes it illegal for Medicare to cover that medical care. But how can you be certain your MSA is enough?
First, Medicare has created review thresholds where it will tell you if the MSA is enough. Those thresholds are meant to limit workloads, and a settlement outside of those thresholds does not limit your need or ability to prepare an MSA. Medicare’s review thresholds are:
- For Medicare beneficiaries: $25,000 settlement or higher
- For claimants with a reasonable expectation of Medicare enrollment within 30 months of the settlement date: $250,000 settlement or higher
Second, in the scenario where the settlement falls below those thresholds, an MSA is still potentially helpful. Those MSAs will not get Medicare’s stamp of approval. But setting up MSAs follows a formula. If the nurse preparing your MSA treats it like an MSA to be submitted, then, the MSA will be enough to protect the injured person and pay for future care.
Finally, if your settlement falls within the review thresholds and the organization preparing your MSA refuses to submit the MSA, it is best to ask “why?” Is that organization expecting Medicare to reject the MSA it put together? If yes, perhaps that MSA does not protect you like one set up under normal Medicare rules.