What is a Medicare Set-Aside in Workers' Comp?

My Workers’ Comp Attorney Says I Need a Medicare Set Aside: What Does This Mean?

Medicare is a Federal medical benefits program to assist those without means to pay for their own treatments. How does enrollment in, or plans to enroll in the Medicare program affect a Mississippi workers’ compensation case? Attorneys representing injured workers’ are required to protect potential interests of Medicare when settling a workers’ compensation case. There are several different scenarios with how this comes into play. This is basically a “no double dipping” rule. An injured worker can not receive benefits for future medical treatments from a workers’ comp insurance company and also receive governmental, medicare benefits for the same injury.

As long as the settlement paperwork reasonably addresses this issue, all should be well. But here are some things that need to be kept in mind. First, if an injured worker is currently receiving Medicare benefits at the time of settlement and the settlement is for over $25,000, Medicare must approve the settlement. Second, if there is a reasonable expectation that the injured worker may apply for Medicare benefits within 30 months of the settlement and the settlement is for more than $250,000, Medicare must approve prior to finalization of the settlement. Approvals will hinge on whether or not enough of the settlement funds are “set aside” to cover the estimated future costs of treatment. Finally, even if a case does not fall in the prior categories, it may be a good idea to err on the side of caution and set some money aside.

How Does a Set Aside Work?

The amount of money out of a settlement that is to be set aside for future treatments will be clearly detailed in the settlement paperwork that will be presented to the Mississippi Workers’ Compensation Commission for approval. If approved, that money still goes to the claimant, or injured worker. It is the injured worker’s responsibility to keep track of the money in the set aside and to keep careful records of how it is spent. So long as the money is all used for treatment of the injury at issue in the original comp claim, once it is exhausted Medicare should then kick in and start paying.

This can be a little tricky, so you should always seek the advice of a competent workers’ compensation attorney. Watch this video for more explanation…….