What is a MSA? A Medicare Set Aside Allocation, otherwise known as a MSA, simply put, is an account where funds are set aside to pay for medical expenses that would ordinarily be covered by Medicare.
When is a MSA needed? MSA's are typically used in workers compensation settlements, though they can also be used in liability claims as well. A MSA is appropriate whenever there is a need to protect Medicare's interests. Some MSA's, those meeting specified review thresholds, should be submitted to the Centers for Medicare and Medicaid Services (CMS) for approval.
When does a MSA need to be submitted to CMS and how is that accomplished?
Review thresholds are set by CMS as a workload threshold. Current review thresholds published by CMS indicate that CMS approval of a workers compensation MSA is appropriate when:
The claimant is a current Medicare beneficiary, AND the total settlement is greater than $25,000, OR
The claimant has a "reasonable expectation" of Medicare entitlement within 30 months, AND the total settlement amount is greater than $250,000.
Set Aside Specialists will take care of the submission process for you. Once you have agreed to the proposed MSA Allocation amount, Set Aside Specialist will submit the proposed MSA for approval.
Medicare currently has not established review thresholds for MSAs in liability cases, and only select CMS offices are reviewing liability MSAs. The need to prepare and/or submit a MSA to CMS on a liability case needs to be addressed on a case by case basis.
What if I'm not sure I need a MSA? Set Aside Specialists will review the case and help you determine if a MSA is indicated. If a MSA is not needed, but you still need to know what the future medical care is worth, Set Aside Specialists will prepare a Medical Cost Projection, and we'll even give you a break on it. If later you decide to convert the cost projection to a MSA, we will apply your previous payments and only charge you the difference in the fees.
