workers comp lump sum settlement/ medicare set-aside account

[Dutchy]

:(Can anyone share an experience of lum sum workers compensation settlement(being on regular medicare) whereby a medicare set-aside account to be held at a bank for future medical expenses and the ramifications after that limit has been used to obtain regular medical coverage from medicare?

What happens after $5000 is used up in set-aside account? Will medicare pay for medical bills?

Has anyone been penalized by medicare or billed beyond their set-aside account amount? Like having to pay for full medical coverage up to the lump sum settlement?

Offer on table w/these stipulations. Sounds like to much trouble. Is this account necessary to do so?

Things are suppose to be simplified & easier to understand once you get into retirement!!!! Help

[jayne]

nothing about medicare or WC is simple................cant answer your question I settled without a medicare setaside...But wanted to take a minute and welcome you

[hurt at work]

check with you`r lawyer he/she may be able to write the language in the settlement papers to help you with that issue,my lawyer did this for me incase I win my ssdi.So call and talk with you`r lawyer soon as possible.

[MJC]

Welcome to the forum! It was explained to me that when you take a medical settlement it goes into a Medicare Set Aside account, like a trust. Someone pays your medical bills for you from your account. When the money is used up.....then Medicare will begin to pick up the expenses for your medical related to that injured part of your body, but not until all the money you settled for is used up. Hope this helps. I still have open medical because I can't see them putting a dollar amount on this injury and it is still on going as I am awaiting another back surgery approval and my injury was in 1999. Best of luck to you and hope we see more of you on here.

Cajun Hugssssssssssss,
MJC

[kate]

The amount of the set aside is determined on a case-by-case basis and should be reviewed by the Center for Medicare and Medicaid Services (CMS), when appropriate. Once the CMS determined set aside amount is exhausted and accurately accounted for to CMS, Medicare will agree to pay primary for future Medicare covered expenses related to the WC injury.

If the IC does not get approval for the set aside amount, they are usually responsible for any costs above that.

[MJC]

kate,
What I posted that was explained to me sound correct? It more or less sounds like what you posted. Am I understanding this correctly? Thanks and God Bless!

Cajun Hugssssssssssss,
MJC

[kate]

MJC,
Yes, pretty much the jist of it, although in some cases, the injured worker can "self-administer" the funds instead of a third party. (Not recommended).

And even in your case where there may be future surgery necessary, you could settle with an MSA. They need to take into account any future needs, inflation, prescriptions, etc. In serious injuries, the IC usually has to get a "life care plan"

To submit a MSA for approval the submission should include:
1) A Cover Letter with the following information:

* Claimant’s Name
* Claimant's Date of Birth
* Claimant's Health Insurance Claim Number (HICN) or Social Security Number
* Claimant’s Address and Phone Number
* Claimant’s Counsel Information
* Entitlement Information
* Employer's Information
* WC Insurer
* State of Venue
* Attorney Representing Employer or WC Insurer
* Injury/Disease Date
* Type of Injury/Disease
* Total WC Settlement Amount
* Proposed Medicare Set-aside Amount

2) Evaluation of Life Expectancy
3) Claimant Release Form
4)  Life Care Plan (If the claimant’s injury/disease is extensive/serious)
5)  A copy of the proposed settlement agreement.
6) Current and Future Medical Treatment
7)  Patient Medical Recovery Prognosis
8) Total Settlement Amount.
9) Identify the total amount of the settlement that is designated for future medical benefits and how calculated
10) Medicare Set-aside Amount
11) Designate the administrator
12) Medicare Set-aside Arrangement Account
13) Fees

Does this help?

[Dutchy]

jayne Wrote:nothing about medicare or WC is simple................cant answer your question I settled without a medicare setaside...But wanted to take a minute and welcome you

[Dutchy]

Thank you Jayne for the warm welcome. Can I assume that you are not on medicare therefore, you did not needa msa

[MJC]

Kate,
Yes, it does help....thank you very much. A life care planner was mentioned if we ever consider this. I agree that it would not be a goood idea for me to handle payments myself. I am going to copy and paste this info for safe keeping. Thank you so very much. God Bless!

Cajun Hugssssssssss,
MJC