Having an overall idea of MSA and its working
Getting injured due to someone else's negligence may require you to file a personal injury lawsuit to claim medical care coverage for your future medical needs and the amount of distress you had to experience. Whether you are covered by workers’ compensation or Medicare or expected to obtain coverage from Medicare, you may have to have a Medicare Set-Aside account for reimbursement from the government for your medical care for an injury. There are many individuals, below the age group of 65, who receive this special fund through the Social Security Disability Insurance (SSDI) program.
The rules relating to Medicare Set-Aside (MSA) have been continuously evolving and are a bit difficult to understand for a layman. Some of the critical pieces of information are being shared below to help you get its essence right.
When do you need an MSA?
Medicare becomes a secondary payer if you have some other sources of coverage for a personal injury, such as illness or accidents. It could be a worker’s compensation or any employer-backed insurance program. Since the received settlement amount may not be sufficient to cover your future medical needs arising out of the injury in concern, Medicare as the second payer may have to bear the cost and for disbursal may require you to open an MSA account as mandated by the Medicare Secondary Payer Act to pay for your future medical needs.
You may have to get an MSA account under one of these two conditions – 1) you are qualified for Medicare and have received a compensation of $25,000 or more, or 2) You may not be eligible for Medicare currently but can be expected to receive Medicare coverage and have obtained a settlement of about $250,000.
When do you qualify for an MSA?
As per federal laws, Medicare has become your secondary payer, which means it will not cover the cost of your injury until and unless the compensation, such as workers’ compensation or personal injury settlement money, you received has been correctly used on your medical care.
As soon as the claim is settled, some amount of the settlement money has to be kept separate for medical care in an MSA account whether you are eligible or expected to be eligible for Medicare. This allocated amount will cover your medical bills, and Medicare will begin disbursing the amount once all the funds have been exhausted, and the responsible entities have done mandatory reporting on time following the rules.
However, MSA guidelines are quite stringent as well as complex on how the amount can be used. It is mandated that the reimbursement amount must be used on medical procedures and medicines relating to personal injury that falls under the realm of Medicare, and only the approved payment should be made.
MSA procedures are detailed and need a lot of documentation. You need to submit medical records of the last two years, complete payment details for the same period, prescriptions, and an evaluation referral form for Medicare Set-Aside. Any error in paperwork can lead to rejection of the claim. That's why it's necessary that you meet a health policy specialist and attorney, such as TD&P Consulting Medicare Set Aside, for assistance.