Medicare Set-Aside Allocation (MSA)

A Medicare Set-Aside Allocation is an agreement which takes place at claim settlement, after a thorough review and evaluation for the proper allocation of injury related medicals, which prevents a shifting of burden of future injury related medical expenses from the current carrier to Medicare.

If such shifts of burden are determined at the time of claim settlement, Medicare can make a claim against the employer and/or insurance company for reimbursement.

A Medicare Set-Aside Allocation and approval by the CMS (Center for Medicare and Medicaid Services) is required with any settlement in which:

• Class I – The claimant is a Medicare beneficiary/recipient at the time of settlement, regardless of the settlement amount.

• Class II – The claimant is not yet receiving Medicare benefits, but has passed the following two-prong test:

• The total amount of the settlement (indemnity plus medical less attorney fees) is over $250,000.00

• It is reasonably expected that the claimant will become a Medicare recipient within 30 months of the settlement.