Medicare Set-Aside Allocation (MSA)
A Medicare Set-Aside Allocation is an agreement that 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.
