The Settlement Alliance

Medicare Set-Asides

Our team works with Medicare experts to ensure that all Medicare-related obligations are met.

Medicare Set-Asides

At times, negotiating the payment of future medical bills can be an essential component of a favorable settlement. If a plaintiff has adequate insurance to cover future medical bills, or if the individual has received a sufficient monetary settlement to be used for those expenses, the federal government may not allow Medicare payments to be distributed for healthcare that is "related" to the tort.

However, in the event that the plaintiff's funds are exhausted, Medicare may then be responsible for covering any additional expenses for future injury or illness related to the lawsuit. Attorneys may choose to advise their clients receiving Medicare benefits to "set aside" settlement proceeds in order to ensure funds are available for "related" healthcare.

Federal law requires that Medicare not pay for medical services related to a lawsuit when the award includes funds for future medical expenses, until all such funds are properly expended. In other words, Medicare becomes the secondary payer to the settlement or award, and if the burden of healthcare is shifted to Medicare, by law, their interest must be protected.

What a Structured Settlement Planner Can Do to Help You

To create a proposal with a recommended allocation amount, a MSA specialist will evaluate the total costs of future medical care and review the plaintiff's medical history, pre-existing conditions, current treatment methods, physician statements, life expectancy, and other factors.

To obtain approval from the Centers for Medicare and Medicaid Services (CMS), you'll also need to furnish all settlement documents and signed releases from the plaintiff. If the plaintiff's medical condition significantly changes, the MSA can be revised. Based on the type of underlying case, a variety of factors come into play that only an experienced settlement planner can handle.

In all situations, it is good practice to educate client regarding what an MSA is, the risks of not setting aside funds and how to administer those funds and to have client sign acknowledgement release. To learn more, contact our planners about your Medicare Set-Aside today.

We are proud to partner with the highest rated structured settlement providers in the industry:

  • American general Life Companies
  • Berkshire Hathaway Structured Settlements
  • MetLife
  • Mutual of Omaha
  • New York Life
  • Pacific Life
  • Prudential