Medicare Set-Aside

Who Needs an MSA?

General Liability, No-fault, and Workers’ Compensation cases

Failure to comply with MSA reporting requirements can result in a penalty of $1,000 per day. 

MSA Required for Group 1 & 2 

Group 1

The Claimant who is receiving Medicare and the settlement is greater than $25,000

Group 2

The Claimant who is not receiving Medicare and the claim is greater than $250,000

                                                                         &

"Reasonably” expected to apply for medicare within 30 months of settlement How do you define “Reasonably”?

•   Claimant has applied to SSDI
•   Claimant denied SSDI but is appealing or plans to appeal
•   Claimant is at least 62 ½ yrs old
•   Claimant has End Stage Renal Disease but does not yet qualify for Medicare based on Renal Disease 

 MSA Not Required for Group 3 

Group 3

The Claimant who is not receiving Medicare and the claim is under $250,000

                                                   &
Will not apply for Medicare within 30 months of settlement

Increase your success by providing as much information as possible at the time of referral

We need the following information at the time of the referral:

1. First Notice of Injury/Loss
2. Last 2-3 years of medical payouts
3. Last 2-3 years of medical records
4. Estimated settlement amount
5. Claimant’s Medicare or Social Security Disability status
6. Rated Age (if available or we will obtain if indicated)
7. Completed Referral Form (online, faxed, or mailed)
8. Life Care Plan/Medical Cost Projection (if available)
9. Pharmacy Summary (if available)
10. Court orders (if applicable)

* In order to submit the MSA for review, we must have a CMS/Medicare General Release signed by the claimant.