An Overview of Medicare Set Aside

What is MSA?

It is the calculation of the medical benefits which the applicant uses to pay off the treatment expenses incurred due to any injury caused to him or her in the near future. Medicare Set Aside has been established to make sure that Medicare is not the main payer of all the medical costs related to the injury mentioned in the copy of the settlement.

What is an MSA arrangement?

It is a document that indicates the medical needs related to injury and also some related costs that may crop up in the near future. Expenses that are covered and the cost that would be actually paid by Medicare are only identified here.

Why is an MSA arrangement necessary?

The intension of the Medicare Set-Aside Arrangement is to grant funds to the workers who might injure themselves in the future. This fund is actually the compensation amount which a worker is qualified to get. If an injured worker incurs a treatment cost which is more than this qualified amount then Medicare pays that additional expense.

The Medicare Secondary Payer statute was established in the year 1980 to make sure that Medicare is not the primary body accountable for paying the medical costs spent by the beneficiaries of Medicare who are also insured by other insurance companies. Its main purpose is to see that the burden of these injury-related future expenses is not shifted by these insurance and other companies on the shoulder of Medicare alone.

How a MSA arrangement develops?

The development process of a Medicare Set-Aside Arrangement is a very complex process. The following factors are involved in the process:

ü  Evaluation of both the medical and the billing records.

ü  Verifying the eligibility factors of the workers insured.

ü  Obtaining the various clinical guidelines that need to be followed.

ü  Carry out an enquiry of the Medicare lien.

ü  Identifying the future medical needs, the items covered by Medicare etc.

Where the fund is kept and what is happens when it is exhausted?

The MSA funds are deposited in an account where the interests also get accumulated. This amount is withdrawn only for meeting the injury related medical expenses of a worker which is otherwise covered by Medicare. The accounts officer is liable for maintaining all the necessary records of the disbursements made.

When all the funds are exhausted, an accounting audit is finally conducted before the injured worker’s Medicare benefits have been totally restored and there are no prospective possibilities of termination.

After going through this article you must have got a clear idea about the concept of Medicare Set Aside and its purpose.