Who requires a Medicare Set-Aside (MSA) and what is its purpose?

Who determines the amount to set-aside?

If you are presently receiving Medicare benefits and resolve your case, an MSA might be necessary. Furthermore, if you are not currently a Medicare beneficiary but expect to enroll within the next 30 months after the settlement, you may require an MSA. If you fall under either of these groups and fail to establish an MSA, your eligibility for Medicare coverage of medical conditions related to personal injury could be forfeited.

An expert in “allocations” reviews your injury related medical records and provides suggestions based on the extent of future care that will be funded by Medicare. The organization hired to conduct the allocation determines the portion of your future medical care that will be covered by Medicare and forecasts it over your remaining life expectancy to establish the recommended set-aside amount. If CMS review is requested, Medicare may not necessarily approve the allocation suggestion outright. Medicare might demand a higher set-aside amount compared to the one proposed in the MSA allocation.