What is a Workers Compensation Medicare Set Aside?

A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a financial agreement that “sets aside” a portion of an employee’s workers’ compensation settlement to pay for future medical services related to the workers’ compensation injury or illness.

In other words, the employee’s WCMSA funds that have been “set aside” must be “used up” before Medicare will pay for treatment related to the workers’ compensation injury, illness, or disease.

The amount of your workers’ comp settlement money that will be put in a separate fund earmarked for the WCMSA is determined on a case-by-case basis.  The law requires only that a “reasonable” amount be set aside for future medical expenses.  (To see how it is determined how much is “reasonable” read PART 2 of this article.)

When Do I Need a Workers Comp Medicare Set-Aside?

Medicare Set-Aside law is very complicated – as well as constantly changing – but here are some basic considerations for determining if you need Workers Comp “Medicare Set-Aside” (WCMSA).

If your injury or illness is such that it looks like you will need to collect Medicare to cover your medical expenses either now, or anytime in the future, you typically need to have your attorney establish a Workers Comp “Medicare Set-Aside” Trust Fund.

The goal or purpose of the Workers Comp “Medicare Set-Aside” is to to reimburse the government for future medical expenses related to your injury. The reasoning behind this, is that since the employer caused your injury, the employer should be responsible to pay your medical costs – and NOT the government.

In other words, the government wants to make sure that you use the funds in your Workers Compensation settlement towards future medical expenses – before Medicare “picks up the tab”. And so they require a Workers Comp “Medicare Set-Aside” (WCMSA) as part of your settlement.

How Does a Workers Comp “Medicare Set-Aside” Work?

A Workers Comp Medicare Set-Aside is like a “trust fund.” A specialized company will evaluate what they expect your future medical needs and costs to be. Then they recommends an amount that should be set aside for future medical care. The government must then approve the amount to be set aside. The money to be set aside is then placed in a Medicare Set-Aside account – either in one lump-sum or by being funded with a “structured settlement annuity” that replenishes the WCMSA account over time.

An administrator will be appointed to manage your Workers Comp Medicare Set-Aside trust. They may ONLY use the money only to pay for medical care related to your work injury or illness.

Experienced Workers’ Compensation Medicare Set-aside Attorneys

It is very important to consult with an attorney specialized in Workers Comp “Medicare Set-Aside” (WCMSA) immediately if you have a workers’ compensation claim. You need an attorney who can advocate for your rights, and ensure enough money for your future medical needs is set aside – while also ensuring that you obtain the other maximum benefits to which you are entitled.

Our experienced Workers Comp attorneys have established Workers Comp Medicare Set-Aside trust accounts for hundreds of clients – ensuring that their medical needs are always taken care of. Call our attorneys today for a FREE consultation today.

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